A whistleblower has drawn attention to alleged Medicaid fraud in Ohio involving some members of the Somali community, highlighting potential vulnerabilities in the state’s home healthcare system.
Mehek Cooke, an Ohio attorney and conservative commentator, told Fox News Digital that the problem has persisted for more than a decade, involving millions in taxpayer dollars.
Cooke described a scheme in which providers within the Somali community allegedly receive payments for elderly patients who do not require extensive care.
“They’re just rubber-stamping a lot of these,” she said. “Then that same individual, a week later, that’s supposed to be bedridden, is all over social media, whether they’re out dancing at a party or something like that.”
Doctors reportedly have been pressured to approve claims for patients with fabricated medical conditions.
Cooke stressed, “It’s not a Somali issue or a race issue. Our waiver system in Ohio was built with compassion… but it’s being looted today.”
According to Cooke, loopholes in Ohio’s Medicaid program allow providers to claim payments of up to $91,000 per individual annually.
Kickbacks to approving doctors are reportedly part of the system, and nearly all beneficiaries are coached to meet eligibility criteria they do not genuinely fulfill.
Oversight gaps compound the problem, with independent evaluations infrequent and Department of Medicaid visits sporadic. Providers allegedly instruct beneficiaries on how to mislead doctors during assessments.
State authorities have documented similar challenges.
In 2024, Ohio’s Medicaid Fraud Control Unit (MFCU) received over 1,150 allegations of fraud, resulting in 116 indictments, 129 convictions and $17 million in restitution and penalties.
This year, ten providers faced indictments totaling nearly $2 million, while previous cases involved over $1.2 million in fraudulent claims.
Federal enforcement has also targeted companies billing for ineligible patients and inflating service hours.
Cooke emphasized that Ohio is not unique. She cited a parallel Medicaid fraud scandal in Minnesota involving Somali providers and suggested that similar weaknesses may exist in other Midwestern states.
“I think every state, in addition to Ohio, should be asking for audits of their Medicaid systems,” she said.
The financial consequences are substantial. Fraudulent claims divert taxpayer dollars from genuinely needy individuals and undermine public confidence in home healthcare programs.
Experts stress that systemic reform, more rigorous oversight, and strict enforcement are essential to prevent further abuse.
Cooke’s warnings highlight the tension between well-intentioned social services and opportunities for exploitation.
While Medicaid aims to support elderly and vulnerable residents, loopholes and insufficient supervision create risks that bad actors can exploit.
State and federal authorities are evaluating these claims to strengthen accountability measures and ensure that resources reach those who truly need them.
The allegations serve as a reminder that oversight and transparency are critical to preserving the integrity of programs designed to help society’s most vulnerable populations.
Cooke’s call for audits and reform underscores the need for vigilance and corrective action to protect taxpayer dollars and maintain public trust.
