The Problem Was Never the Home Care

Somewhere in a flat near Morse Road in Columbus, a daughter is awake at three in the morning. Her mother had a stroke and cannot turn herself in bed, so the daughter turns her, every two hours, to keep the skin from breaking. She does this on a weeknight before a shift, the way her family did it in a refugee camp in Nepal, the way they would have done it in a village in southern Bhutan before soldiers came. The State of Ohio pays her a modest hourly wage to do it, because the alternative — a nursing-home bed — would cost the taxpayer several times more. A magazine has decided this woman is part of a crime ring. Its evidence is her last name.

We are the BhutanWiki Editorial Team. The encyclopedia we maintain is neutral by design; every other page on this site states facts and lets the reader decide. This page is different. This is the editorial, and on this page we say what we believe. We believe a recent investigation by an American political magazine, which framed Bhutanese-Nepali refugees in Ohio as a Medicaid home-care fraud ring, got the diagnosis backwards. So we did what we do. We researched it — our own community's corner of this story, honestly, prepared to find whatever was there. What we found is that the problem was never the home care. The problem is the state mechanism.

The door the state opened

Start with the claim doing the most quiet work in the article: the suggestion that immigrant-run agencies somehow got tens of thousands of people onto Medicaid. They did not, because under Ohio law they cannot. No home-care agency in Ohio has the power to approve anyone for Medicaid. That power sits entirely with the government, through a chain the provider never controls.

Here is the chain, as written in Ohio's own rules. First, financial eligibility is decided by the county — the County Department of Job and Family Services checks income and assets. Second, clinical eligibility is decided by an independent case-management agency, which sends a nurse or case manager to assess the person in their home and determine whether they meet a Nursing Facility Level of Care. Third, the state itself — the Ohio Department of Medicaid, or the Department of Aging for the PASSPORT programme — approves enrolment, after which a case manager writes the service plan that authorises the specific hours of care. Only after all of that does a provider agency show up to deliver the authorised hours and bill against them.

The agency is the last link in the chain. Never the gatekeeper. The assessor who decides eligibility is, by design, a different party from the one who gets paid — that separation is the whole point. Ohio Administrative Code rule 5160-46-02 spells it out: enrolment runs through county financial determination, an in-person comprehensive assessment, a level-of-care finding, and state approval. The provider has no approval authority whatsoever.

So if tens of thousands of refugees were enrolled, it is because the state assessed them and approved them — through its nurses, its caseworkers, and its own eligibility rules. You may dislike that the rolls grew. But the people who grew them were county clerks and state-contracted nurses, not the family running a home-care agency. Blame the gatekeeper if you must. Do not blame the people who walked through a door the state opened, measured, and stamped.

The backstop the state made optional

If approval is the state's job, so is verification. And here Ohio's own auditor has already written the indictment — of the system, not of any community.

The federal government required states to put Electronic Visit Verification in place for home care: a simple check that a real worker showed up to a real client at a real time before the visit is paid. Ohio built the system. It spent roughly $146 million on it. Then it declined to make it mandatory. For years, EVV was not a condition of payment for personal-care and home-health services in Ohio. The money went out whether or not a verified visit was ever matched to it.

In November 2024 the Ohio Auditor of State published what that choice produced. Looking at calendar year 2022, auditors found that only about 44 per cent of personal-care and home-health claims were matched to a verified EVV visit. More than half were not. In dollars, roughly $1.1 billion of about $2 billion in paid claims could not be matched to any verified visit at all. Ohio did not finally require EVV as a condition of payment for home health until March 2025.

Read that sequence slowly. The state built a verification system, paid for it, and then let providers bill a billion dollars a year without using it — for years — by choice. If money walked out the door unverified, that is a design failure with a date and a signature on it. It is not a trait you can pin on a refugee population that happens to work in the sector the state declined to verify. A hole the state left open is the state's hole.

The watchdog the state abolished

This is where the story turns from negligence to something closer to nerve.

Since 2014, Ohio's roughly forty-billion-dollar Medicaid programme had a dedicated watchdog: the Joint Medicaid Oversight Committee, a standalone body with its own staff and its own actuary, built to keep continuous eyes on the largest line in the state budget. In its 2025 biennial budget bill — House Bill 96 of the 136th General Assembly — Ohio abolished it. The committee's separate existence was rewritten out of the Revised Code and its funding zeroed out by fiscal year 2027. In its place the statute now offers a single sentence of obligation. We quote it because the thinness is the point:

"The standing committees of the house of representatives and the senate that primarily consider legislation governing the medicaid program shall meet jointly … to oversee the medicaid program on a continuing basis."

That is the replacement for a staffed, funded, dedicated oversight committee: a requirement that lawmakers occasionally meet. By multiple accounts the provision was slipped into the budget in the small hours before the vote, while the committee it killed was mid-probe into a major Medicaid contractor. We are deliberately not printing dollar figures we cannot fully verify, and we are not naming individual politicians' campaign relationships, because we hold ourselves to the standard we are asking of others. The fact that survives that caution is damning enough on its own: in the same window that Ohio discovered a billion dollars in unverified claims, the state dismantled the very body whose job was to catch it.

Hold the two halves of this together. A government lets its verification system rot for years by choice. The same government then abolishes its dedicated oversight watchdog and defunds the function. And then a magazine, surveying the wreckage, points at refugees. The state built the hole, removed the alarm, and a publication has decided the people standing nearest the hole must have dug it. That is not analysis. It is misdirection.

Clustering is community, not conspiracy

Much is made of how many of these businesses share an address, a building, a postcode. The implication is that proximity proves collusion. It does not.

Refugee and immigrant communities live close together for reasons older than any waiver programme. They cluster to keep language within earshot, faith within walking distance, a temple or a kirtan reachable on foot, childcare and elder care inside the same few buildings, the right vegetables in the corner shop. Franklin County holds the largest Bhutanese population anywhere outside Bhutan. Of course the businesses that serve that community — the agencies that employ its workers and care for its elders in a language they understand — share streets and postcodes. A shared address is the signature of a dense community, not of a cartel.

We will be honest about the other half of this, because honesty is the only thing that makes our defence worth reading. Address clustering can be a legitimate investigative lead. When many entities operate from one suite, an auditor is right to look. But a lead is not a finding. On its own, a shared address is a concentration metric and nothing more — and entirely legitimate operators cluster too, in the same buildings, for the same human reasons. Concentration tells you where to look. It does not tell you what you will find.

Caring at home is the cheaper choice

There is a deeper irony the investigation never reaches, and it is fiscal, not cultural.

Our community keeps its elderly and its disabled at home. We bathe them, feed them, sit through their nights, rather than send them to assisted living or a nursing home. The article treats this as suspicious — all these people on home care. But home care is the cheap option. Medicaid pays far more for a nursing-home bed than for an aide at the kitchen table. Keeping people out of institutions is not a loophole somebody discovered; it is a deliberate, decades-old policy goal. The home and community-based waivers exist precisely to divert people away from the most expensive care Medicaid funds. That diversion is the policy working as designed.

So when refugee families choose to care for their elders at home, on a Medicaid waiver, they are steering people away from the single most expensive thing the programme pays for. They are doing the cheaper and the more humane thing at once. To frame that as a scam is to punish a community for saving the taxpayer money in the most dignified way available. It is backwards.

A surname is not a network

And now the centre of the whole exercise — the move on which the article's force depends, and the move that does not survive a moment's scrutiny.

The investigation totals up Medicaid payments to people named Adhikari and presents the sum as if a shared last name were a criminal organisation. It even gave the tally a name: the payments were published under the headline "Party Like An Adhikari," over a column of company names beside a subtitle explaining that these were firms "controlled by people with a single Bhutanese surname." Adhikari is one of the most common surnames among Nepali-speaking people in the world. Grouping Medicaid dollars by "Adhikari" is the arithmetic equivalent of adding up every dollar paid to anyone named Smith, or Johnson, or Patel, and announcing the discovery of the Smith crime family. Even a commenter beneath the article noted that Adhikari is simply a common Nepali name. Aggregating by surname is not journalism. It is a sum dressed up as an accusation.

We can prove this with the article's own list. One company on that "Adhikari" tally, Almis Home Healthcare, was actually examined by the State of Ohio. We read the Auditor of State's compliance report. Almis had been paid roughly $12.7 million across more than 236,000 services — a large operator, exactly the kind the article wants you to assume is dirty. The audit checked ninety-seven practitioners and the owners against the federal Office of Inspector General exclusion database and Ohio's own exclusion list, and found no matches. The nurses' licences were valid. All one hundred sampled visits were backed by a signed plan of care. The total improper payment the auditors could find, after all of it, came to a few hundred dollars — the largest single item being $219.07, a routine billing overlap of the sort that turns up in audits of providers of every background.

That is what being on a list of surnames is worth when it meets an actual audit. A company the article implicates was tested by the state and came back essentially clean. We did not have to strain to find this counter-example. It was sitting on the magazine's own table.

Fraud has no ethnicity

None of this means fraud is fictional. Medicaid and Medicare home-care fraud is real, it is documented across many American states, and a great deal of it — much of it larger in scale — has been committed by native-born operators with no connection to any refugee community. We hold no brief for any individual who steals from a programme meant for the sick and the old. Wherever that happens, it should be investigated and prosecuted: by name, with evidence, through due process. That is not in tension with anything we have written. It is the whole of it.

What we object to is the selectivity. The same conduct becomes an immigration story only when the operators are brown and foreign-born. The investigation's own author promoted the findings with the line that "Bhutanese are described as greedier and more cunning than Somalis" — a sentence that tells you exactly what the exercise was for. Run the same query against any other surname and you would produce a similar-looking table and no article, because there would be no villain the audience was primed to want. The tell is not what the investigation found. The tell is whom it decided to count.

And note what the investigation did not find. After all the tallying, it produced photographs of cars and holidays and a comfortable life — and not a single cited criminal conviction. The one legal action it could point to was a federal Department of Labor penalty for underpaying workers. Sit with that. The grand evidence of refugees gaming the welfare state turns out to include a case of refugees paying their own staff too little. That is the opposite of the lazy-freeloader story the article is selling. Visible wealth is not proof of fraud. Owning a nice car is not a crime, in this community or any other, and due process applies to people a magazine happens to dislike exactly as it applies to everyone else.

The cruelty of "send them back"

Beneath the article, in the comments, the mask comes off entirely. Send them back, the readers write. This is a culture of tribal dishonesty.

We want to be precise about who "them" is, because precision is the antidote here. These are people the United States itself invited. In the early 1990s, Bhutan expelled roughly a sixth of its population — Nepali-speaking southern Bhutanese, the Lhotshampa — in a campaign of forced exile whose documentation is the founding purpose of this encyclopedia. They spent some fifteen to twenty years in United Nations refugee camps in eastern Nepal. Beginning in 2008, the United States, through its own State Department and under United Nations protocols, formally resettled tens of thousands of them. They did not sneak across a border. They were screened, processed, and welcomed, by name, by the American government.

So when a comment section says a whole people carries a "culture of tribal dishonesty," we recognise the sentence. It is the precise logic — a population defined by ancestry, then declared collectively untrustworthy, then told to leave — that produced the expulsion we exist to document. The method that emptied southern Bhutan of its Nepali-speakers in the 1990s and the method that turns a common surname into a crime ring in 2026 are the same method. We are not going to watch it reappear, aimed at the same people, in a country that took them in, and stay quiet because the venue has changed.

What we believe

So here is the closing argument, stated plainly.

Prosecute real fraud. We mean it. Where an operator of any background bills for a visit that never happened, for a client already in a hospital bed, for a person already in the grave — charge them, name them, convict them, exclude them. The records show this happens, and it should be answered with the full weight of the law and the dull, unglamorous work of an audit.

But a surname is not evidence. An ethnicity is not a conspiracy. A shared building is not a crime scene. Choosing to care for your dying mother at home, on the cheaper of the two options the state offers, is not theft from the public — it is a gift to it. And a government that left its verification optional and then abolished its own watchdog does not get to launder its failures through the faces of the refugees it resettled.

We researched the Bhutanese home-care angle because it is our story to research, and we were ready to find fault in our own community if the evidence led there. It led somewhere else. The problem was never the home care. The problem was the mechanism — built to fail, stripped of its alarm, and now blamed on the people standing closest to the hole.

The encyclopedia is neutral. This page is not. This is what we believe.

— The BhutanWiki Editorial Team

References

1. Rule 5160-46-02, Ohio home care waiver program: eligibility and enrollment — Ohio Administrative Code
2. Rule 5160-3-08, Level of care determination criteria — Ohio Administrative Code
3. Ohio Department of Medicaid Electronic Visit Verification Performance Audit (November 2024) — Ohio Auditor of State
4. Section 103.41, Joint medicaid oversight — Ohio Revised Code (as amended by H.B. 96, 136th General Assembly)
5. Report: Ohio budget dissolved Medicaid oversight committee amid provider complaints — Axios Cleveland
6. Almis Home Healthcare, LLC — Franklin County Compliance Examination — Ohio Auditor of State
7. Bhutanese refugee resettlement in the United States — BhutanWiki
8. U.S. Refugee Admissions Program — U.S. Department of State