‘NATIONAL EMBARRASSMENT’: Mehek Cooke Says Ohio Lacked the Political Will to Confront Medicaid Fraud

On Tuesday, Mehek Cooke, Daily Signal’s senior national security & legal analyst, testified at a hearing examining fraud within Ohio’s Medicaid system. This transcript of Cooke’s testimony has been slightly edited for clarity.

Opening Statement

Thank you very much for the opportunity to testify to strengthen Ohio’s Medicaid funding system so that we could prevent fraud. I have testimony written, and I’m going to follow it as much as I can, given that we have five minutes. But I want to stress that Medicaid is really meant for vulnerable Ohioans. 

Every dollar spent that is stolen from people that really need it in the state of Ohio, it’s an elderly person, disabled, kids with autism. So it doesn’t just merely try and steal tax dollars. It’s actually destroying public trust and monies that we need for people in Ohio who are most vulnerable.  

I’m testifying because I have spent several months investigating as a taxpayer, an attorney, an Ohioan. 

I also work with the Daily Signal now on Ohio fraud.  

Whistleblowers back in December came to me and shared that they had gone to several legislators, several offices and the attorney general’s office, because there was massive fraud in the state of Ohio. They specifically asked the attorney general’s office to please not share their names, but they wanted to share all the information because they feared to be stoned to death within that community. 

They identified the Somalian, Nepalese, and Bhutanese community where this fraud was occurring. And primarily, there’s a language barrier.  

Many individuals don’t speak English, so they seek out certain providers that have either a common background or can speak multiple languages.  

I was told that individuals would sometimes, seeking home health care services, would not only be coached by home health care providers, but in many cases, the applicant was actually accompanied by a home health care provider that would speak for them in terms of ailments. 

These providers conducted MRIs, CT scans, and then declined to actually allow for approvals because their medical need was not substantiated. 

Thereafter, these providers were threatened, verbally told that we are going to go back to our old provider that stamped this paperwork for us, and some healthcare services, one of them in particular, actually said, “I’ll make it worth your while,” which sounds like a kickback. 

I provided all of this information to the Ohio Department of Medicaid, all of the providers that are potentially engaging in fraud, in addition to even the home health cares that are complicit in this and asked them to do an investigation.  

I also went to the attorney general’s office. They specifically first asked for the names of the whistleblowers, which I wouldn’t give them, attorney-client privilege. 

I represent them now, and they cannot protect them. They continued to push, saying that they would subpoena me, and I told them they had all the information needed.  

But this is the type of cover-up when you’re unwilling to actually work with somebody who’s providing information, detailed summaries, explaining how the fraud and corruption works. 

At the Department of Medicaid, I spoke to several people there on a phone call and specifically said, “All you have to do in addition to auditing, start with anybody who closes their program starting in December. That will tell you, because they’re moving to Pennsylvania. I’m not asking you to track the fraud to Pennsylvania, but if you actually stop and audit just anybody closing, that will show you fraud because their biggest concern was racism.” 

Well, fraud is not the cost of doing business, and it’s certainly not racist to look into allegations and to make sure fraud isn’t occurring.  

During my recent visits in months, we had one home care health center that had thirty-four providers in there. Many people weren’t even present. One or two people that we were able to speak to didn’t even speak English. 

They didn’t know how to actually explain what home health care services were. They would call somebody else, and they’d tell me to come back. 

On my fourth visit, three men cornered me and stated that this was, that they do not want to provide home health care services to me, which is fine, but continue to intimidate and call this racist when all we’re doing is asking basic questions in our state. 

I have outlined a lot of potential opportunities for us to strengthen, but one of the biggest things the governor’s executive order does not do is if you stop new home health care services, that’s great.

But what about the ones that are already existing? What about auditing those? And the fact that we haven’t done that is shocking to me. 

There are places where individuals are billing. So an individual could come in and make seventy-five thousand dollars at a home healthcare provider. 

You add a parent, you add, let’s just say my, my parents in addition to my husband’s parents, now you’re making close to two hundred and fifty to a half a million dollars. 

Those all should be flagged within the system.  

We also need to inquire independent, verified medical necessity. And there’s two options here.  

The General Assembly could actually create doctors that are approved to look at home healthcare services and patients, so that way you have an approved system of doctors that you have verified on a list. 

They need to apply, they need to be verified, they need to be in good medical standing with the board. Those are opportunities for us to strengthen this.  

The other way to strengthen this is also to make sure that we have an accessor that’s independent, that’s not tied to any agency, that’s actually verifying the recipient’s limited functions, the medical necessity, the hours. 

Also, we need unannounced site visits.  

I guarantee you, if people had visited from the Department of Medicaid the number of times I went to these facilities, you would have known that there was something wrong.  

The Attorney General’s office had letters underneath the door, several other mail that just wasn’t opened. 

It’s a completely vacant building. There are hundreds of these.  

In addition, I think we need to also look at shell company patterns. Ohio should implement automated analytics to help with shared addresses, phone numbers, emails, bank accounts, ownership, duplicate overlapping of business registrations.  

This is something that has occurred over and over again, where you have one person that can own up to fifty to sixty home healthcare and make millions. 

My biggest issue right now is the Department of Medicaid, through a public records request, has refused to give us how much we’re spending on home healthcare systems. After five months, their response to me, our tax dollars, their response was, “Please go talk to our vendor.” That’s unacceptable in this state. 

You made me wait five months to tell me that our tax dollars are sitting at a vendor and, and we think that’s okay? There needs to be a transparency checkbook for Medicaid. Every single dollar, we don’t need patients’ names, but every single dollar that we have going out that are our tax dollars, we want that transparency. 

We want that audit for everybody. It doesn’t matter who the home healthcare service is. And lastly, I’ll just tell you, whistleblowers need protection. They shouldn’t have to come to attorneys like me.  

And yes, I did this pro bono because I believe them and I believe this work warranted a lot more from Ohioans and a lot more from our leaders. 

We need whistleblower protections.  

And if you look at the crime, I know that we are strengthening the penalties. Under current law, Medicaid fraud is involved less than $1,000 is treated as a misdemeanor. I know you’re looking at penalties, but I support the idea of also using Medicaid fraud as a predicate offense under the Ohio’s engaging in a pattern of corrupt activity. 

That way you have another way that we can bring law enforcement and the U.S. Attorney’s Office in terms of enforcing our law. I think it’s weak right now, and that’s another area for strength. 

 I’m happy to answer any questions. Thank you for the opportunity to testify.  

Testimony Q&A

Mehek Cooke: I’m happy to answer any questions. Thank you for the opportunity to testify.

Rep. Jennifer Gross: Thank you so much for your time today, Ms. Cooke. Representative Romer.

Rep. Bill Romer: Thank you so much. I appreciate you being here. One of the things that I’ve looked at is the number of patients that are approved by doctors. Do you think it would be effective if we had some sort of tracking mechanism that would say these doctors approved something at 500 or 1,000% of the average, versus doctors who might do one or two approvals for home health care patients on a yearly basis?

Mehek Cooke: Representative Romer, that’s an amazing question, and I think that’s where data analytics are important. We’re not just auditing the home health care services or the individuals trying to get certified—that needs to be strengthened as well—but also having a tracking system.

So whether you have an Ohio-approved list of doctors, or you have doctors who have to submit how many individuals they are approving, that’s a guaranteed way to know there are some doctors approving, as you said, 500%, versus some that are only approving 10%.

Rep. Romer: Thank you. No follow-up.

Rep. Gross: Representative Timms.

Rep. Desiree Timms: Thank you, Chair, and thank you for being here today and for your testimony. I have a question about the complaints you received before you represented the client. Did you reach out to the attorney general’s office? And if so, did you ask your—

Mehek Cooke: I can hear you.

Rep. Timms: OK. Houston, we have landed. So I ask this question because, at the last hearing, the Medicaid Fraud Unit came and talked to us about how many cases they had open and how they were working on this, and that these units exist in every single state under federal statute.

And you are saying that you reached out to the attorney general’s office and nothing was done—nobody called you back—or they just wanted the person’s information?

Mehek Cooke: I am saying that the whistleblowers reached out to several offices, including the attorney general’s office. They asked for anonymity, and they were not granted that.

They then came to me and asked if I would represent them, because they did not want to go on record with any of these offices because they do not want to be—it’s a cultural thing—“stoned to death,” as they say. They don’t want to lose their lives or their livelihoods.

So when that information was shared with me, I shared it with the Department of Medicaid, the attorney general’s office, and I also followed up with Keith [Faber], Ohio’s auditor.

The attorney general’s office was notified about these complaints almost a year ago. When I notified them in December, it was because things started heating up in the media, and that’s the only reason they called me.

Then they wanted the whistleblowers’ names, and I refused that based on attorney-client privilege. I also gave them a list of everything they would need to investigate. Did I answer your question, Representative Timms?

Rep. Gross: Follow-up?

Rep. Timms: Yes, please. Thank you, Chair. It seems odd, based on what you’re saying and how typical whistleblower complaints go. I will say that. I’ll move on to the next question.

Mehek Cooke: What part is odd? To the chair. Rep. Gross, may I ask Rep. Timms what part is odd?

Rep. Timms: I’m asking the questions.

You mentioned that you decided to pop up at a site on your own. I’m assuming wearing your journalism hat or your investigator hat—I’m not sure which hat. But you showed up to investigate a home health care agency—a patient’s home. Where did you pop up at? I’m confused. You said you did a surprise visit and encountered someone who did not speak English. That is what you just said. So I’m asking you, “Where did this occur?”

Mehek Cooke: You made an incorrect assumption. I would never go to somebody’s home. So failed assumption number one.

I went to an office building that is a public office, that is open to anyone that comes in to seek services. I knocked on the door, asked permission to enter, and asked if they provided home health care services.

As I stated in my testimony, the majority of those offices, nobody was present. The couple of people I did see— one was a very young woman who said she didn’t know anything about home health care. She asked, “May I call my uncle?” I said that would be great.

She called her uncle, who asked if I could make an appointment. I said I was happy to come back, but she couldn’t give me any times. I came back the next day, and nobody was there.

This was one office building with tons of offices, mostly with locked doors. These are not personal homes—these are just public buildings where if you wanted to walk in tomorrow you could say, “I’d love to come to talk about home healthcare.”

One individual did go through a bit of information with me and said she generally doesn’t see a lot of traffic. I have all these notes. But for the most part, many individuals were not there, and the few who were either didn’t speak English or really didn’t understand what home health care services were.

Rep. Gross: Are there any other questions? Representative Lett.

Rep. Crystal Lett: Thank you, Chairwoman. I wanted to follow up on what Representative Timms was asking. It’s interesting to me that you are showing up at the location the business is based out of. I know, because my son has disabilities and we receive the SP services and the home health services to help us so that he can live in the home. Those home health care providers are not at the office. They are generally dispatched throughout the community all day long.

So I would just like to state that for the record, I would like for you to opine on that, but I don’t think it is a reasonable expectation for the entire office to be staffed during the day. That is not the purpose of home health, and that would be more concerning to me than providers being out in the community. I’d love your thoughts on that.

Mehek Cooke: Thank you for the question, and I’m glad your son is receiving care.

Generally, I’m not expecting a full office, but usually there’s one or two people there—I have a friend who has since sold his home health care. I mean, it’s a functioning office, administrators taking calls, coordinating care, handling issues when aides don’t show up.

My grandmother is in her 90’s, and she also receives home health care services, and there is always someone available to respond. So even that home health care has some– an administrator or somebody to say, “Oh, the home health care aide didn’t come. Let me help you. Let me transfer somebody else.” But there’s always a couple organizers.

But in these cases, there was nobody. It was a complete ghost town. And the couple people that were manning the office really didn’t understand home health care systems. And the other thing that I found really interesting was every door had a sign. Most of them said they were open eight to three, eight to five, but they weren’t open. So that was the other part that was confusing.

I did call a couple, and generally, it was a man on the other side, and it wasn’t, “Hi, this is Home Health Care Kindness.” It was, “Hello. Who’s this? What do you want?” And I’m like, “Maybe I’ll just go knock on the door and see if they’re willing to answer my questions.” Face-to-face goes a long way versus text messages and phone calls with people.

Rep. Gross: Follow-up?

Rep. Lett: So you’re saying there were one to two people present?

Mehek Cooke: There were, there were empty offices. There were, like, one to two, and, like, let’s just say there was one home… So it’s 34 home health cares.

One office may have had one person. The third floor may have had one. That’s what I mean, but they’re all separate home health cares.

Rep. Lett: Through the chair to the witness, just to clarify—there are 34 individual provider companies in that building?

Mehek Cooke: Yes, that’s correct.

Rep. Lett: Thank you for clarifying for the record.

Rep. Gross: Representative Hall.

Rep. Derrick Hall: I work in health care in my day job, right? So I find fraud, waste, and abuse abhorrent in all its forms.

So again, I appreciate the things that you’ve come to talk about today. My question was gonna be there’s sort of the bucket, and we talked about, I think, last committee meeting around MFUCU. I can never say it right. But the unit that does the investigating—MFUCU from the AG’s office.

And I asked them in committee, I said, “Hey,” I said, “Do you have enough in the way of resources?”

And the answer was like, “Yeah, we have nine hundred cases, but I don’t wanna say no to more resources,” but, I think we all know what he was trying to say: “I need more resource.”

But that’s just one bucket.

So my question, though, is you mentioned the site visits and last count there’s over 850 home health agencies in Ohio. I think it’s closer to a thousand now. Yeah. I’m all for site visits. If I had my druthers, they all would have a site visit unannounced multiple times a year.

My concern, though, this is my question for you is, it doesn’t appear, though, that either ODM or ODH are appropriately staffed to be able to carry out that level and that number of inspections.

We all talk about fraud, waste, and abuse and how this deplorable thing. But if we’re not gonna fund additional resources to root it out, I mean, fund, I don’t just mean saying, “Let’s require ODH to do a thousand visits,” without giving them more manpower and more funding. Sorry, womanpower too, by the way.

What are your thoughts on the resource allocation to actually rooting out fraud, waste, and abuse?

Mehek Cooke: Thank you for the question. So I think that there’s two buckets here, and you’re right. The AG’s office definitely needs more help and more fraud-based investigators for home health care to you name the fraud.

If there’s a welfare program, we’re going to have fraud. There’s always going to be a level of activity that people engage in. So I do think more resources, they’re in priority, but I think we have to start with the basics. Look at the application for home health care services. Only six states allow for a relative to do that.

Only six states, Ohio, and of course, you guys know Minnesota. So we have to start thinking about maybe it shouldn’t be our own family members and take that into account. Look, I just shared with you, my grandmother has a home health care service aide that comes in. My mother could have easily applied.

She’s very qualified. That really shouldn’t be the funding that we’re providing family members. Our family members are here for love and support. They really shouldn’t be the ones that are caregivers that are then dipping into funds for somebody like Representative Letts’ child.

I think that’s unacceptable.

So let’s look at that. Let’s review it. We’re one of six states, so I say that again. In terms of rooting out the fraud, though, our home health care application, I mean, anybody can apply. I’m sorry, but the bar is so low, and then we expanded services during COVID, and we never pulled those back to really rethink what is home health care really for?

What is that purpose? And then the other part of this is the only way that we’re going to detect it is to be smart by it. We have lots of people working at Medicaid. They need to start detecting at a certain level. Let’s do an audit. They’re not doing that right now.

Representative Hall, they don’t even know how much they’re sending home health care systems because after over five months, they asked me to go to their private vendor on how much money we’re spending.

So if we were to call Medicaid right now and I was to say, “Do you know which vendors have spent $2 million or $5 million?” They would have to say, “Can I put you on a hold for five months? Let me go ask my subcontractor.”

That’s deplorable. We should be able to actually have a system where you can get on, your family members can see who’s getting the most Medicaid funding.

I mean, that’s how you detect fraud when there’s spikes. This is common sense. You don’teven need a law degree or anything else.

So I think some of it also is creating a blueprint, which I have reached out to the White House Task Force to ask for one, to work with them to provide to this committee.

There should be a blueprint of internal protocols that we have where we’re not just throwing more money at a controlling board and saying, “Well, I need more money for fraud detection.” Some of this is just use your common sense. Gosh, this provider is spending millions.

Rep. Gross: Follow-up? 

Rep. Hall: I just had one more follow‑up question. There’s a famous nurse who once said that sunlight is the best disinfectant. With regard to transparency, do you think there’s a role for AI to go through large amounts of data and look for patterns—particularly in detecting fraud? 

Mehek Cook: Representative Hall, I’m 100% supportive of this. AI can detect higher levels of spending, but you still need a physical person. There’s no replacement for you or me or anyone else on this committee to go to a home health care office and say, “My gosh, they haven’t been open in a month. There’s nobody there even taking phone calls. It goes to some random man who says, ‘What do you need?’” 

AI could be instrumental here. There are ways we can reduce costs without using manpower for every single thing. 

AI could also be used for what Representative Roemer brought up earlier. Doctors should be reporting to Medicaid how much they’re billing and how many patients are receiving home health care. We could use AI to look at the top 25 doctors and conduct periodic audits there if we don’t have enough manpower. 

And while we’re talking about this, we should also look at nurses. There are several nurses—and I have a list of them that I’m happy to send to the new attorney general when he takes office—who I’m told allegedly are rubber‑stamping a lot of this. So maybe we should rethink who should be providing and approving home health care. Perhaps consider doctors and not nurses. 

Thank you for the question. 

Rep. Gross: Committee, are there any other questions? 

Thank you, Ms. Cooke, for your testimony today. We really appreciate you. 

Before we conclude, I’d like to ask one more question, and I don’t mean to put you on the spot. Do you happen to remember a street or office building that members could visit themselves to see what you saw? 

Mehek Cook: Yes. I have an address here: 2700 East Dublin Granville Road. The nice thing is there’s also a bank there if you need to do banking, but you could easily stroll in. 

There are 34 individual home health care centers that are empty. A couple of people have staffed them in the past. There are also trucking companies there with nobody inside. And if I’m not mistaken, that same building billed almost $66 million to Ohio Medicaid. 

Rep. Gross: Yes. 

Mehek Cook: And this was flagged in December to officeholders. I think it’s a national embarrassment for me to have to go on live television and talk about our state like this—especially when you have the Daily Wire coming in to talk about what we could have done together as a state, as a group of individuals, to correct this. 

Thank you so much. 

Rep. Gross: Thank you, Ms. Cooke, for your testimony today. We really appreciate you.