
On this episode of The Federalist Radio Hour, John Hart, CEO of government transparency nonprofit https://www.openthebooks.com/, joins Federalist Senior Elections Correspondent Matt Kittle to discuss ballooning Medicaid fraud in states like...
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We are back with another edition of the Federalist Radio Hour. I'm Matt Kittle, senior elections correspondent at the Federalist and your experience Sherpa on today's quest for knowledge. As always, you can email the show at radio the federalist.com follow us on x@fdrlst. Make sure to subscribe wherever you download your podcast and of course to the premium version of our website as well. Our guest today is John Hart, CEO of Government spending tracker Open the Books as the Federalist reported this week. Open the Books Deep dive into a Department of Health and Human Services documents shows an explosion in state administered Medicaid payments to in home service provider personal assistant. Those areas a surging industry fraught with fraud. John, thank you so much for joining us. I know you have been extremely busy of late.
A
Well Matt, thank you so much for having me on again and unfortunately it is a very deep pool of waste that we have to dive in. But we're glad to get the scuba gear on and and shine a light in these dark crevices of of the federal bureaucracy.
B
Yeah, you've got some sea creatures, some real leviathans going on down there.
A
We could go with this analogy all day.
B
I think we could but monstrosities no doubt. The the, you know the the area that I think is just amazing. Payouts to personal assistance services have ballooned nationally between 2018 and 2024 over that seven year period. It's amazing what you folks have found. Tell us a little bit about your findings and where all of this information is coming from.
A
Yeah, well, first of all, I, I give a lot of credit to dhs. They, they dropped an unprecedented to help with public transparency a few weeks ago and it included 270 million payments made to Medicaid from 2018 to 2024. We did a big review of that and there's different entities have been looking at this. Dr. Oz has done a great job of drilling down into California and he's been very outspoken in those areas. But one of the unusual cases or states and case studies we found is Pennsylvania. We found that Pennsylvania's personal assistant service received a more than 10,000% increase since 2018.
B
Just amazing.
A
Either there was a 10,000% increase in demand or people figured out how to game the system and understood that this big opening left for fraudsters was exploited in very grotesque ways. And your report did a great job of really highlighting, you know, one of those schemes, which was Himal Patel. He was charged with wire Fraud, you know, 59 year old who milked billions out of, out of the Medicaid system by setting up essentially ghost home health care services. And now what's interesting is, you know, the home health issue is something that, you know, I remember when I worked for Cockburn in the House and the Senate, this was, this is a known problem for 25, 30 years and longer. And so we really have to step back because there's so much detail in our report and what Dr. Oz is highlighting. And the real question is, why have we set up a system that simply invites people to defraud it to the tune of hundreds of billions of dollars a year? And the answer really is that the incentive structure is really set up to be defrauded. And I always talk about the Milton Friedman box where there's four ways to spend money. You spend money on yourself, you spend your money on someone else or someone else's money on yourself. But the least efficient of those four is you spend someone else's money on someone else. That's what government does. And so the reason we have a constitution that limited the size and scope of government is because the founders, who were very learned people in touch with reality, understood that the incentive structures within government were always going to be susceptible to misbehavior, corruption, fraud. That's why they wanted to limit the size of government and concentrate it in the hands of we, the People and keep it closest to the people they represented, particularly the states. Instead of following that example, we've allowed the administrative state to balloon over the past hundred years. So now we have these massive gargantuan federal agencies and then we wonder why there's so much fraud. And so I think I really commend the administration for shining a light on this and for the president to elevate J.D. vance as the anti fraud person in chief, if you will. Yeah, and so it's an important step because the. But, but it sort of raises the question of well you can, you can only go so far getting rid of the fraud. You have to, you have to use the debate about the fraud to really tackle the systemic problem we have which is again these massive entitlement programs that, that I believe are too, they're too big to succeed. We have, we have a federal government that is too big to succeed. And yes we need to go after the fraud, we need to eliminate it. But in the process of doing that I hope we get to this bigger conversation of how are we really going to get our arms wrapped around the safety net problem we have that's the cause of our unsustainable debt and deficits which is a threat to our national and economic security as a country.
B
Yeah, I do too John, you mentioned it before but I mean this is something we have been dealing with for a long time and no surprise since we have seen the rapid expansion of the administrative state, the bureaucratic state from the Wilson Wilson era of course going all the way back to the turn of the 20th century. But you know we've talked about this before. I grew up in Wisconsin and there was a senator there, maybe the last Democrat who was conscientious about government spending. His name was William Proxmire. He used to have the Golden Fleece Awards talking about wasteful and fraudulent abusive spending. Some of the worst exhaustion examples of that of all time. And you know that was an award that he gave out from 75 to the late 80s. We are still dealing with that. And look at what is happening in Minneapolis and Minnesota these days. And that is just the tip of the iceberg. So do you think we really are at a point now to finally deal with the systemic problems of, of the massive welfare give outs and how the incentives work to incentivize fraud?
A
Yeah, you look, I'm, you know, I'm always a glass half full person. I'm always optimistic about how, how these you know, findings can lead to bigger systemic reform. And, and part of the reason I'm optimistic is. I get this is part of my lived experience. This isn't sort of happy talk, pie in the sky thinking. And, you know, back, back in the, you know, when Coburn was in the Senate, we went after the, the famous Bridge to Nowhere earmark, you know, in 2005. And we. He lost that vote 82 to 15 by 67 votes. So, you know, he was, he was, quote, you know, blown out by the, by the earmark caucus. But that, that defeat really set us up for victory. And, and what we saw was, you know, we won that. Won that battle or lost the battle, but we ended up winning the war because it galvanized public support. And the argument we made at the time is that earmarks are the gateway drug to Washington spending addiction.
B
Yeah.
A
And in order to, in order to really get things done within our system, you have to be willing to make incremental wins and taking incremental gains. Now, getting rid of fraud itself, it's an enormous. We're talking way more than the earmark problem. You know, we're talking in the hundreds of billions of dollars. You know, the GAO estimates the federal government loses between 233 billion and 520 billion in fraud every year. So it's a massive problem. But even that's only about a third of our deficit spen. And so my hope is that as we talk about these individual examples that you highlighted in your story, the case of Pennsylvania, and we give people the big picture look at the scope of Medicaid payments. We also described how Medicaid payments have gone from about $110 billion since 2018 to 185 billion, but the number of claims has been actually less. Roughly the same.
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Yeah.
A
So we've seen all throughout government, you see these big deltas where the numbers of claims tend to be the same, but then the spending is way, way up. And so again, part of the explanation is that it's just fraudulent. People figure out how to game the system because we've created a system that invites itself to be gamed. And so I am hopeful that, you know, Vice President, other, other people who are taking this problem seriously will understand that, you know, it's not enough to just talk about the fraud. We need to deal with the systemic problem. And the other thing that people will tell you privately that they'll very rarely admit on the record is that most. Well, I'm not going to say most. I'm going to say many, many members and many very senior people. Administration understand they agree with everything we're saying right now, in other words, they understand that there's not enough fraud in the system to really fix the entitlement problem. But they believe, and I think correctly, that the public will not trust them or anyone in Washington to fix the really big problems if you're not willing to fix the little problems or the small problems. And it's a biblical principle. Whoever's faithful with a little will be faithful with much. Whoever's dishonest with a little will be dishonest with much. And so you have to win people's trust and confidence by dealing with things like earmarks, by dealing with things like the stupidity of the examples that we highlighted in Pennsylvania. And then you set yourself up to really make the big reforms and you'll have a constituency of change ready to back you up with those really hard votes.
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One of the biggest problems has been forever is that there's an acceptance of this, right? I mean, you have not only lawmakers, but a jaded American public. They're like, well, I guess that's just part of the deal. And that's, you know, that's what surrounds, that's what you get when you have corruption basically. And laziness is part of the corruption as well. But a lot of people are making a lot of money off of this failed fraudulent system you mentioned. You know, this is not just a Pennsylvania problem, although the issue is obviously very big, which happens to be Dr. Oz's home state, if you will. At least it was when he was running for Senate back in 2022. But you know, you look at New York and you point this out in this is, I think, something that should raise some eyebrows and concerns. Certainly in New York, the elderly and disabled may hire friends and family to serve as in home personal care assistants. You know, those who take care of the elderly and disabled, as we mentioned, provide, you know, basic services for them. That's big Medicaid payout area funded by taxpayer money, lots and lots. The scheme is especially popular in New York State, which has seen $72.7 billion in such spending from 2018 to 2024, according to the OTB analysis. Now that's a lot of money and there are just egregious notable examples of fraud in that system. So why do we have that kind of system if it is just so tied in? It's just so fr. Is so intrinsic to it.
A
Yeah, well, again, it goes back to what I was just saying. I think the way to change it is literally doing what we're doing right now is because we're, we're highlighting the examples. You know, in, in our report we talked about, you know, there's $120 million kickback scam in with something called the Royal Daycare Facility in Flushing, Queens where you. It actually bribed patients to enroll. And so it's, it's sort of different layers of fraud. It's like a. It's absurd the degrees people go to, but when the incentives are there to make millions of dollars, people will do extraordinary things to get that money. And they do. And when they feel like they're going to get away with it. And so simply by doing the reporting, doing the oversight, capturing the data that we do and then people like you actually publishing, that's part of the process of fixing it. And you have to get people. The thing with, you know, as you know well is that the art of getting things done and change is getting people mad about the right things. It's getting them really focused and animated about issues that are really going to affect their lives and that do affect their lives. And when you're competing with all this other noise and nonsense on TikTok or whatever, you have to be able to cut through. And Nick Shirley has done a brilliant job, obviously in Minnesota, you bet, with the, the quote, leering centers.
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They have a lot to lear in Minnesota, don't they? Yes.
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And so. And that exists all over the country. But it's one thing to sort of talk about it abstractly. It's another thing to go in and document. And that's. And again, that's part of why it was so valuable for DHS to do, to do the data dump because in some ways they're almost like admitting look, we know this problem is bigger then we don't even have the staff to understand and get our arms wrapped around it. And by the way, that was the whole impetus too of the Cohn Obama bill to put all government spending online. We wanted to create an ecosystem that would crowdsource oversight because the task was so enormous that our oversight team in Washington couldn't possibly understand every area of government waste that there was to identify. And so that's really how change happens. So I am optimistic because when normal people see this information, they get their hands on it, they hear about it, they kick the tires on the data and realize yeah, these people really are authentic. They're dealing in an evidence based world. They're not dealing with simply hyperbole and propaganda and nonsense and you can go look up the data yourself and double check it all. Then you start to build momentum. There's plenty of periods in our history recently when that's succeeded. The Tea Party movement, you know, we, we successfully reduce spending for at least a time. And I think that can be, that constituency is ready to be reanimated and re redeployed if you will to for this problem.
B
I think so. I think people are very angry about what is happening in Minnesota. It's hard to miss that story even as the accomplice media has done its best to shift attention or not cover that story. But this is, this is something that's you know, just bursting at the seams. As a matter of fact related to that story in Minnesota, you have the headline today that Governor Tim Waltz, Democrat Minnesota Governor Tim Walz laid out his anti fraud legislative package one day after the White House paused $259 million in federal Medicaid payments to the state until a comprehensive action plan is laid out to fight fraud. That from CBS News reporting. Let me ask you this though. John Waltz dealing with fraud, isn't Tim Walls pushing anti fraud measures kind of like JB Pritzker handing out diet tips?
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Yeah, I think that's true. Yeah. Yeah. Look, he, he had, he, you know, he had his moment. If he was serious about this, this never would have become a story. And, and in Minnesota I think sadly the, the, the entire system was gamed and rigged to be exploited and, and used as a patronage vehicle. And that's, you know, he's paid, he's paying the price for that and he deserves to. But let that, let that be a cautionary tale for anyone Any governor, any public official around the country that if you play games with us that the technology is moving so fast that you are not going to be able to keep this hidden. And the Minnesota case was interesting too because I'm on the board of a group called the State Financial Officers Foundation. And one of the really dumb things Minnesota did is they got rid of their treasurer's office. Typically, 99% of the time I'm in favor of getting rid of offices no matter what they're called, but particularly if you don't have great transparency laws, the treasurer or financial controller can be the last backstop and protector and make sure that these things don't happen. And then when you get rid of these internal checks and balances again, you just, you create, you create a system of opacity and darkness where bad things are more likely to happen. And Governor Walz had plenty of opportunities to prevent this and he didn't. And in fact he facilitated it and exploited it.
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Indeed. Our guest today is John Hart, CEO of Government Spending Tracker Open the Books. Great report out this week. You can find it on their website at. It is otb.com open the books.
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Yeah, open the books.
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That's right. That's right.
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Substack is where you'll, you'll get the most, most recent reports.
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Yeah. And, and it's, it's good because you can take a look and you'll see well, well presented the, the charts and the graphs that go along with the explosion of these state operated Medicaid funds that have occurred over a seven year period through 2024. But you know, I, first and foremost, I look at the Minnesota case and it seems like there's no doubt to me that this was driven in large, well, I shouldn't say large part, but certainly a significant part of it was driven because politics, I mean this was making sure that constituencies were getting lots and lots of funding so that they could secure votes. Now they'll tell you something different about that, but that's what it appears to a lot of Americans and, and understandably so. So with that said, the question that a lot of Americans are asking right now, will anybody ever be held accountable for this or anything for that matter?
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Well, I hope so. Look, and I think the administration has taken steps obviously to prosecute fraud more aggressively. I think that's absolutely the right thing to do. And they need to target Republicans and Democrats because there's no innocent side here. But we hear a lot about protecting democracy, but often when it's Democrats saying it, they just want to protect Democrats, not democracy. And I think we're seeing that. We gave Shapiro's office a chance to respond and they declined. What is that? Why is, why is he not willing to give an answer, provide some context to his own constituents? What does that say about his level of respect for the people that he represents?
B
Right.
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B
Josh Shapiro, of course, the Pennsylvania Democrat governor who has clearly has higher aspirations for higher office. Is the is the answer to that question and you don't know it directly from him or his office because they refuse to answer these important questions. Like you why did this category of spending climb 10,000%? I think that's a legitimate question to ask and they didn't want to answer it. But do you think that Josh Shapiro, with his higher political aspirations, doesn't even want to broach the topic? Because if he does, and groups like yours keep digging, it's going to look worse and worse for him.
A
Absolutely. Look, I think it's in his interest. And again, this is true for any governor. It's in their interest to get ahead of this. And if there was a mistake made, you need to own it and take responsibility and describe all the ways you're fixing it. But you're not going to be able to run from it. I mean there's again the technology that's part of what's so exciting. I think we're on the cusp of A renaissance of citizen led accountability through AI and technology. And we're, we, you know, we're doing a whole initiative on that as well. But he's not going to be able to sweep this under the rug. I mean it's too, it's too big of a bump. It's a mountain under the rug that he's going to be tripping over on his way to the, his, his, his campaign for president.
B
I want to talk about that the use of AI in just a bit because I think that's fascinating and as you mentioned, it's something that you had open the books are, are looking into. But on the radio earlier this week I was talk this issue. In fact we had one of your great researchers on the show in, in Omaha to talk a little bit more about the report and a caller had some interesting ideas on how to deal with this fraud. One of the things he had mentioned and I can't intelligently speak to this because I, I just don't know how the system is set up but he said that we should have specific fraud, government fraud courts, even if you wanted to add waste and pieces in there as well. But, but specifically fraud courts like we do with deportation courts, you know, specifically set up to deal with this massive problem. Do we have such a thing anywhere in this country? And what do you think about it? Do we need such a thing?
A
I think that's a, I think that's a fantastic idea. I think it would, I think we need a process to, to, to expedite the, the, the hearings on these issues, but to also deal with a massive scope of it. I mean that's, you know, it's clearly an issue with immigration is, there's not there, there aren't enough people in the system to, to you know, deal with all the cases. And so I think with fraud there are so many. Again it's, it's so easy to just, it's a mind numbing amount of, of waste and fraud that we see. And so I think that's, I think that's a great idea. And, and again this is where you know, I'm usually not in favor of more of more offices but sometimes you know, money can be spent well if you're, if you're preventing far more waste from, from happening as a result.
B
How about some of what we see in for instance Somalia when opponents are caught engaging. How about some of that style of punishment? Well, it is a massive problem and it's getting bigger. We talk about Minnesota, that has been the spotlight, but there are states where they're going to make Minnesota look like a piker. California immediately comes to mind. What have you seen there in terms of Medicaid spending growth? That is to say this, this blue state using federal taxpayer dollars to expand its Medicaid programs. And what about the fraud there?
A
Yeah, I mean, yeah, California is, you know, sadly the golden child of all this. You know, we've, we've seen payments ballooned $127 billion. So. And the only state that's higher with, with Medicaid spending is New York at 142 billion and Texas 60, 64. Massachusetts at 55, New Jersey 46. So it's mostly blue states, but it's, it mix of red and blue based on population. But, but California has been, has been one of the worst. And, and again, I think with California, that in particular also the home health problem has been, has been out of control there and it's loosening, it's loosening the requirements. It's making it, making it easy for people to sign up. And so I, I commend, you know, Dr. Oz for, for really shining the spotlight on the, on the California cases because it's, you know, it's one of the big and you know, it's a uni party government, sadly.
B
Yeah.
A
Very little internal accountability and people in California are just, are going crazy at the amount of waste and fraud we see in their, in their state.
B
Yeah. And it's, and I listen, let's give Gavin credit, Gavin Newsom, you know, a little bit of sympathy here. It's very difficult to track this amount of fraud when you only have a 950 SAT. Right.
A
I just commend you for your love, for your compassion. I think it was 960.
B
960. I didn't mean to undercut him.
A
Yes, well, be accurate and open the books, man.
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Listen, he's, he's just like you and I with his sats. And so it's difficult to really get into this issue. You know, I, I joke around, but you had mentioned before that Gavin Newsom and Josh Shapiro and any bureaucrat that wants to try to hide this, it's getting increasingly more difficult. Not just because of the great, you know, shoe leather work that we've seen in Minnesota by an independent reporter. You're not getting this from the corporate news outlets, which is again, sad. But now you're going to get something that has been in the works for a long time. It's called citizen journalism. It goes alongside with independent reporters. But these are, these are people who are just concerned about spending in their government. These are the people that attend local school board and county board meetings and hearings, and they're getting that information. Some of these folks are really getting good at tracking that. But now AI is here, artificial intelligence that can do all this stuff in a flash.
A
Right.
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Let me ask you, are you, are you using artificial intelligence for this, this. And, and is this truly the next wave of exposing waste, fraud and abuse in government?
A
No. Matt, thanks for the question. Absolutely. So, yeah, I think, you know, let's step back and think about, you know, people are right to be very concerned about AI and the use of the technology. But, you know, I can tell you that there is no technology in history that's ever had a reverse gear. And so, you know, this, this bus is moving. So the question is, how do you steer it? And how can we steer it in such a way that really advances human freedom and flourishing? And so what we've done at Open the Books is we've been collecting government spending data at all levels of government for over a decade, and that's state, federal, and local. And again, the Open the Books work was enabled in part by the Cockburn Obama bill that was passed 20 years ago. But Adam and the founder very wisely figured out that, hey, let's, let's expand that to get state and local. And so I've done all in the interim years when I left Coburn and decided to take over from Adam after he passed away. At Open the Books is I work with Silicon Valley companies and nonprofits and other clients, and I learned that the secret behind AI is an assembly line of data entry. You need three things to make AI work. You need big data, you need an algorithm, and you need processing power. So at Open the Books, data is like enriched uranium. You can use it for peaceful purposes or destructive purposes, and we use it for peaceful purposes. So it's a very, very powerful tool. So what we're doing is we're trying to create what I call the money ball of politics. I don't know if you're a baseball fan or if you know the Moneyball reference.
B
Oh, I do indeed.
A
I Big. So. So the genius for people that don't know it, you know, Moneyball is about the Oakland A's and, and how they.
B
And Brad Pitt, isn't it?
A
And Brad Pitt, yeah, Brad Pitt was in that. He was Billy Dean. It's about the general manager and how they, they realized how to use metrics to the advantage of kind of an underdog small market team. And, and the genius of what they did is they didn't go out and do this sort of fake black magic, hey, let's make up all these new metrics. Instead of, they looked at data and they looked at metrics that were always there but never applied. And they figured out how to apply them and make the small market team way more successful than people thought was possible. And so what AI can do is you take the open the books data set and then you merge it with other publicly available data sets and some that aren't publicly available, things like measuring economic performance, policy outcomes on wage growth, education attainment. And then you train an algorithm to identify the relationships and the structure and the patterns in the data. And then you do pattern prediction. So in other words, it's pattern recognition, pattern prediction. And as you put it, AI can do all this stuff in an instant, whereas it would take us 20 years ago in the Senate weeks to do these Excel spreadsheet projects and comparing numbers. And there's a lot you can do with Excel, but you run into kind of a time crunch. There's just too much data. And so what we're doing is we're partnering with other groups and particularly there's a guy named Paul Allen, not the Microsoft founder Paul Allen, but a guy named Paul Allen who is one of the co founders of Ancestry.com, again, a wildly successful platform where they captured all the genealogy data to help people discover their story.
B
And this isn't the guy that calls the Minnesota Vikings games, right?
A
No, that's not. No different guy. All right, and so, and so what, what we're, what we're trying to do is, you know, the, the way to thwart, again, people are right to be worried about AI and a surveillance state where you give, you give state, the state the power of this technology and they're going to use to conduct surveillance. Well, the best way to thwart a surveillance state is with a surveillance citizenry. And so we're trying to create what we call super intelligent citizens where we don't ask citizens to delegate their power and authority to a mysterious technology. Instead, we entrust them with the power of that technology. So a case study is, let's say you're at a town hall meeting, you can take your phone and we're building an app to do this where you can hold it up and do a live visual recognition on the politician. Speaking of, and then capture their face and then, and you can immediately get a report of all the contradictions in what they're saying in their voting record of their legislation. And you get the super intelligent, report it literally in your palm to make you a better citizen. And that technology exists. And so that's really what we're going to be focused on, especially this year and in the near future, or building these tools again to create, to effectively give every citizen their own terminator robot or special investigator by their side so that they can have the power to hold government accountable. And it's very exciting. And again, that's why transparency laws are so important, Matt, because when the data is out there and searchable, then it can be used to teach tools like the ones we're building where in a free society, the challenge is you want the center of gravity and the authority to always be with we the people. That was the whole vision and purpose of our Constitution. It's a document fundamentally about limitation of power. It's not about creating a permission structure, it's about creating a limitation structure so that you ensure that the electorate has control over the government. Technology is one of the ways that we can make sure that happens and is protected for future generations.
B
That's exactly what you were doing with Cockburn and the Obama Coburn bill.
C
Welcome to your Peloton Pilates era. Built on precision, backed by results and trusted by over 2 million members. Experienced instructors with true Pilates expertise, offering classes for every level from foundational to powerfully challenging. Choose from 10 to 45 minute sessions with little to no equipment, anytime, anywhere. And with the cross training swivel screen, you can move seamlessly from cardio to Matt Press Pilates. Small moves, big impact. Find out more@onepelaton.com Pilates
B
I've got Dan Morgan here on the pod.
C
Say hi, Dan.
B
Hey, how's it going today? It's going good, man. Tell us who you are and what you do. I'm Dan Morgan. I'm an attorney and a managing partner at Morgan and Morgan, which is America's largest injury law firm. That's pretty awesome. I think I saw a billboard of yours recently that said 20 billion. Wonderful. 20 million is an insane number. Yeah, 20 billion recovered. It's actually, I think somewhere north, probably closer to 22, 23 after this year. And each year we get bigger and badder and our army grows. So the number will hopefully keep getting bigger and bigger as time goes on. Awesome. So how does someone get in contact with Morgan and Morgan? What would I do if I got into an accident? Probably the easiest way is dialing pound law. That's £529 from your cell phone. We are always open. Our call center is Always waiting to take take your call. 247365 wow. Dan Morgan from Morgan and Morgan, America's largest injury law firm. Thanks for coming by the show. Thanks for having me. Visit forthepeople.com for an office near you. I want to ask you that real quick here and then I'll get back to AI. But what do you think Barack Obama thinks of his creation now lo these years later? Because he, I mean this was before he was president Barack Obama, he was a senator, worked alongside a very fiscal conservative. You've talked about this before. The aspiring Barack Obama who had aspirations for the presidency saw this as a great issue to run on that he was going to be the transparency guy. But I wonder what he thinks about it all lo these many years later.
A
Yeah, you know I, I, I, I think and I'm just, I'm just going to do a sort of an ideological psychological assessment off, off the cuff here. I think, I think for people who are like authentically progressive are sort of can be double minded between on one hand you want to be a person who really submits and bends the knee to an evidence based conversation but if the evidence based conversation becomes an existential threat to your worldview then people kind of waffle on their, their belief and evidence based conversation. I think the modern Democratic Party is, has been largely taken over by what I would call progressive of fundamentalists and which you know we kind of, we, we've seen on display at the State of the Union and other places. But sure I, I think, I think they're misaligned with the country. I think, I think the average kind of person is, is like this is a no brainer conversation. They would, of course we want more transparency. Of course we believe that we should have an evidence based, fact based conversation about politics. And to me that's an unstoppable political argument. It, it's, it's an unstoppable force. And so I think, I think Obama, if he's, you know, if, if you're really worried about either party being taken over by authoritarians, the number one thing you should support is transparency and then an evidence based conversation because it's impossible for bad actors to really take, quote, take over in a situation where you have an electorate armed with the truth and armed with data. And so I would hope that he looks back at this and thinks gosh, this is pretty inconvenient for a lot of my favorite causes because the data is coming in in such a way it's not very favorable to things like Obamacare. I think if you want to have an evidence based conversation about Obamacare, it's going to be hard to defend the outcomes of that policy. But if you really believe in democracy and not just Democrats, then I think you have to be excited and very, very optimistic about what AI and technology is going to do for the future.
B
Yeah, I, I agree. I just think that they're on the left right now and I think that's a great term. Progressive, fundamentalist. You know, these are folks who are at war with reality. We certainly see it on a number of issues and I don't need to go over them now, but that's what we're, we're at in politics. But the numbers don't lie. You are a guy who, you know, tries to step back from the rhetoric and the politics and just focus on the numbers. That's, that's your job, that's what you do. And as far as the, the, the technologies that you're using, AI, that's, you know, that is, as you say, it's, it's, it's in a critical area to make citizens even more part of, you know, the, that said, you still have to go through the human work of going after the records and getting the information to put that information into the system. I don't know if that will ever change. But where do you see this battle going in the future? Where do you see this a decade from now?
A
Yeah, well, I'll talk about where I see it hopefully in the next couple weeks and then we'll touch on a decade.
C
But sure.
A
But I'll tell you that there's a move afoot and I hope to have more to share on this very soon to do a serious upgrade to our transparency laws to create what we call real time transparency. One of the flaws of USA spending is that there's too long of a delay between the time money, money flows or goes out the door and by the time it's reported, it can be 30 days, 60 days, 90 days, six months. And the nature of sort of the struggle between again, centralized power and we the people is that you could have a great law, but then it gets eroded and degraded over time. And that there's the sort of unglamorous, unsexy truth about a free society is you have to do maintenance, you have to do hygiene, you have to make sure you go through these laws every couple decades and upgrade them. So right now we need an upgrade in our transparency laws because the federal agencies have come up with all kinds of new ways to not Share the data. So there's a move and members I'm working with to do a new bill that would effectively demand and require real time transparency. So that could be a revolutionary step of making sure again making it impossible for any future regime to, to play hide the ball with, with the American people. And, and the, the more again this is all. So much of politics is a center of, again, a center of gravity question because you know, one of, we're in such a dysfunctional tribal time where people just congregate in their camp and they, they don't want to think, they don't want to listen to evidence, they just want to again, the progressive fundamentalists, they don't, they're not many. I mean they're not really interested in reason, they're not interested in evidence. They just want, they only want to hear what's going to agree to their worldview. And you know, sadly, the same is true on the right. You have people who also are not really willing to rethink what they, what they. I just happen to think that if you look at the evidence and I'm very transparent about my biases, it's hard to argue for a bigger government. I think when you look at the evidence and look at the outcomes, you know, throw me into that fight, throw me into that Briar pitch with anybody. And so I'm very, very optimistic about where we could be in 10 years. Because once people get a taste of agency and they get a taste of freedom, you want more and more of it. And that's a beautiful thing of this idea of freedom is that when you experience it, it becomes part of your life and you realize, wow, I actually do have the ability to hold my elected officials accountable. My voice does matter. The extra 30 seconds I might spend on one of our apps or our website, I feel smarter, I feel more equipped, I want more of that. And that whole vision of it's not about expanding federal agencies, it's about expanding your agency and your ability to pursue happiness on your terms and your ability to hold government accountable. That's infectious. That's, that's, that's the essence of being a happy warrior. And when we make it easier for people to do that, then we get more of that and it's in. You know, Paul Allen has, has a great analogy. He describes that, you know, in our, in our system we've allowed these sort of muscles of self governance to atrophy. And, and, and one of the ways to rebuild that is to again is to do the very things we're Doing, you know, to, to do these reports, to do these interviews, to do, to build these tools so that when people exercise those muscles of representative government and accountability, they want more of it and they're more and more equipped to be better citizens. You don't have to reach every single person in the country. If you get 10 or 20% of the public engaged, that's more than enough to completely change the direction of the country. That's why I'm optimistic that in 10 years we could be having a different conversation. And I'll just, I'll throw in one other just historic analogy I think is really, I've been studying the, the history of leeches. Okay. And the use of leeches in medicine,
B
because that's an interesting field of study.
A
Yeah, well, it'll, it'll make sense to you because, okay, every, every generation we look back at something we did 1500 years ago and think, how could we have been so stupid to think X, Y and Z made sense? But one of the things we look back on is the uses of leeches in medicine. That was, was, that was a rage for centuries where people thought, oh, you know, if you've any disease, throw some leeches on it and suck the bad stuff out and you're going to get better. Like there's an intuit, it makes sense on an intuitive level. Until you learn through science that actually, that doesn't help. In fact, it could make you a lot worse. But what's interesting about that matters. There's no, there was no magic point when people realized that was a really stupid practice. It took, it took decades. There's really maybe a 15 year kind of turning point, but we got to a point where that was clearly just totally rejected. And so I'm convinced there's a lot of what we do now within public policy that we will look back on and think, I can't believe we would use those leeches. I can't believe we would just do it that way. It didn't understand, it didn't make any sense. And the only way to make that change happen is to get the information out and to be totally transparent about your worldview. And be transparent and bring people together who have different perspectives and simply build a culture where you, you bend the knee to the evidence. You just look at, okay, what is reality? Are we willing to live in a reality based, fact based world and then let the chips fall where they may? And I think, I think if we do that, we'll see the leeches fall off. We'll see. We'll see kind of the, the decline of a lot of really dumb and bad public policy. But it'll be driven by the electorate. It's not going to be driven by, by sort of an ideological crusader. It's going to be driven by, by what does the evidence show. And that's what the founders believed. And so they were inspired by the Greeks and Romans. And Cicero famously said in 50 B.C. true law is right reason in agreement with nature. So we know what true law is like natural law, when you merge reason and common sense with an understanding of nature in the world as it is. So if you, you can't understand nature if you don't look at evidence, if you don't look at transparent data. And if we focus on building these institutions, then you can get to that reality we want to live in. And so that's what we're just relentlessly focused on at open the books is getting the information out there, giving people the tools that they deserve to make their own judgments. And so I'm hopeful about where we're going to be in 10 years.
B
Well, I know that James Garfield probably hoped that the medicine would catch up. Yeah, it wasn't leeches. It was dirty fingers that were, it's
A
exactly the same era. Yeah. Just peaked in about the 1850s. And it was germ, germ theory that, that I was actually talking to. I'll steal this. I'll give him credit. Scott Rasmussen, the pollster, making the same, same argument you were making about, you know, if Garfield, his, his death probably saved millions of lives because he expedited the acceptance evidence of, of sterilized medicine. And, and that's what we're trying to sterilize our politics. And let's, let's get some of the idiocy and stupidity out of it so that we can, we can help, help people flourish.
B
It is an interesting comparison because as we know, there are a whole lot of leeches in American politics sucking taxpayer money dry. That's, that's what we're trying to get at. That's what open the Books does every day. And they're going to keep doing it because that's the mission. And it's been that way for a long time, thanks to my guest today, John Hart, CEO of Government Spending Tracker. Open the books. You've been listening to another edition of the Federalist Radio Hour. I'm Matt Kittle, senior elections correspondent at the Federalist. We'll be back soon with more. Until then, stay lovers of freedom and anxious for the fray.
C
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Federalist Radio Hour — ‘Fraught With Fraud’: Exposing States’ Medicaid Money Dump
Date: February 27, 2026
Host: Matt Kittle
Guest: John Hart, CEO of Open the Books
This episode examines the explosion of fraud and waste in state-administered Medicaid payments, particularly focusing on personal assistant and in-home service providers. Host Matt Kittle and guest John Hart (Open the Books) discuss shocking findings about ballooning Medicaid payments, systemic vulnerabilities to fraud, notable individual and state-level scandals (with examples from Pennsylvania, New York, and Minnesota), and the critical role of transparency, data, and artificial intelligence in combating government waste. The conversation blends policy critique, investigative findings, and optimism for citizen-driven accountability.
| Timestamp | Topic/Quote | |-----------|-------------| | 03:17 | Release and analysis of $270M in Medicaid payments data; 10,000% increase in PA | | 04:01 | Example of ghost home health care fraud (Himal Patel) | | 07:19 | Historical context: Proxmire’s “Golden Fleece” awards; bureaucratic expansion | | 09:38 | Incrementalism and the true scale of fraud (“hundreds of billions”) | | 13:23 | New York’s Medicaid system and examples of fraud | | 15:18 | Case study: Royal Daycare Facility’s $120M kickback scam | | 18:25 | Minnesota: Federal Medicaid funds paused over fraud concerns | | 19:33 | Critique of Gov. Walz’s response to anti-fraud measures | | 21:05 | On political patronage and accountability in Minnesota | | 27:17 | Proposal and discussion of government fraud courts | | 28:52 | California’s ballooning Medicaid spending and fraud | | 31:54 | Artificial intelligence as the next wave in fraud detection and transparency | | 35:26 | Building “super intelligent citizens” through AI and transparency tools | | 43:34 | Push for real-time transparency laws | | 47:49 | Analogy to “leeches in medicine” and the need to discard outdated policies |
This episode offers a comprehensive, data-driven critique of Medicaid fraud, exposing how systemic incentives in U.S. welfare programs foster waste and corruption. Through concrete state examples, the discussion underscores the need for greater transparency, the promise of technology (especially AI) in public oversight, and the growing power of informed, engaged citizens to drive reform and accountability. Hart and Kittle deliver their findings and insights with clarity, humor, and a dose of optimism, making complex policy issues accessible and compelling.
Listen for:
For charts, datasets, and further reading:
Visit Open the Books Substack and The Federalist’s Medicaid fraud coverage.