CW: Fraud
People often talk about fraud in home‑based care programs in terms of budgets, audits, and criminal charges, but for the disabled people who depend on these services, the consequences are deeply personal. I know this because I live it every day.
I have cerebral palsy, and the Massachusetts PCA program lets me live in my home rather than in an institution. My PCA lives with me, which gives me a level of stability that many disabled people don’t have. Even with that stability, I depend on him for essential, intimate tasks like showering, toileting, and preparing meals. Without that support, I could not live independently.
For millions of disabled people, the stakes are high. A missed shift can mean being stuck in bed and unable to eat, use the bathroom, or get to work or school. These are not hypothetical risks; these are daily realities.
The growing national push to crack down on fraud in Medicaid-funded home care programs affects these realities. Recently, Dr. Oz, the Administrator of the Centers for Medicare & Medicaid Services, said he has been working with Bill Essayli, the acting U.S. Attorney in Los Angeles, as part of a broader federal effort to go after fraud in home-based care.
Essayli said that CMS is auditing health care providers and flagging areas of suspicious billing to federal investigators, who can bring criminal charges if they find evidence of fraud. As part of this process, Dr. Oz sent a letter to California Governor Gavin Newsom, replete with pages of questions and data requests, demanding a “comprehensive program integrity action plan” within three weeks.
Oz identified several areas where his staff believes waste and fraud occur. One of the largest is the state’s In-Home Supportive Services program, known as IHSS, which allows disabled people to hire someone to assist with tasks such as cooking, bathing, and cleaning. According to Dr. Oz, the program’s budget has increased by 348 percent over the past decade.
This national scrutiny doesn’t stop at California. In Massachusetts, two PCAs in South Deerfield admitted to submitting incorrect timesheets for years while working for Brenda Bialecki. They faced legal consequences, but the ripple effects reach far beyond the courtroom.
Every time authorities uncover fraud—whether in California, Massachusetts, Minnesota, or anywhere else—the system responds with more scrutiny, more paperwork, more delays, and more suspicion. Disabled people and advocates have warned for decades that these reactions often harm the very people the programs intend to support.
Policymakers built the PCA program on trust—trust that caregivers do the work they claim, and trust that disabled people direct their care honestly. When people shake that trust, the entire system tightens, and disabled people get caught in the squeeze.
You can see this clearly in Minnesota. Thirty‑five‑year‑old Kayla Guilette creates beautiful paintings with her mouth. She lives independently in a Saint Paul apartment and volunteers at the Como Zoo.
New Wave Home Health Care pays her PCAs—including her friend Christine Sandberg—with funding that the state Department of Human Services distributes from Medicaid reimbursements. In January, the state audited claims as part of the effort to root out fraud in the personal care assistance program, and those audits delayed payments.
For Kayla, that delay wasn’t just a bureaucratic hiccup. It threatened the stability of the care she depends on to live her life, pursue her art, and contribute to her community. When payments stall, PCAs can’t afford to work. When PCAs can’t work, disabled people lose the support they need to survive.
For someone like me, even a short interruption in PCA services can be dangerous. If my PCA can’t come, I can’t shower safely. I can’t use the toilet safely. I can’t prepare food. These are basic human needs, not optional conveniences.
For people whose PCAs do not live with them, the risk becomes even more immediate. A PCA stuck in traffic, a canceled shift, or a delay in authorizing hours can leave someone alone for hours or even days without the ability to meet their most fundamental needs. A delay in paperwork is not an inconvenience; it threatens health, safety, and dignity.
Disabled people have long argued that home and community‑based care not only offers the most compassionate model of support but also provides the best value. Nursing home care can cost states more than $100,000 per person per year. PCA services cost a fraction of that.
Supporting disabled people in their homes saves money, reduces hospitalizations, and leads to better health outcomes. But the moral argument is even stronger: home‑based care lets disabled people live in the community, direct their own care, and avoid unnecessary institutionalization. Programs like PCA and IHSS make that possible. When fraud undermines these programs, it threatens not just budgets but civil rights.
Fraud also fuels harmful stereotypes. It gives ammunition to people who want to restrict or cut home‑based services. It reinforces the false idea that disabled people and caregivers abuse the system, even though the vast majority of us do everything right and simply try to survive. It creates a climate of suspicion that makes it harder for disabled people to access the care they need. And it distracts from the real structural issues—low wages for PCAs, high turnover, long waitlists, and administrative burdens that already make the system difficult to navigate.
For disabled people, the fear is not just that fraud will lead to more oversight. The fear is that policymakers will reduce hours, deny more claims, or enact policies that make it harder to remain at home. The fear is that one day the system will decide that institutional care is “easier” or “cheaper,” even though it is neither. The fear is losing autonomy, privacy, and the ability to live a life that remains self‑directed and rooted in community. These fears are not abstract—they rest on decades of history in which authorities routinely institutionalized, isolated, and stripped disabled people of control over their own lives.
This is why disabled people’s advocacy matters so much. People have fought for decades to shift long‑term care away from institutions and toward home and community‑based supports. They have fought for the right to hire and train their own PCAs, to control their own schedules, and to live in their own homes. They have fought to ensure that disabled people do not get punished for the misconduct of a few. And they continue to fight to ensure that fraud prevention does not become an excuse to undermine the independence of disabled people.
Oversight matters. Accountability matters. But the conversation must center on the people whose lives depend on these programs.
Fraud does not just constitute a financial crime—it betrays a system built to preserve dignity, safety, and autonomy. Policymakers face the challenge of protecting program integrity without creating barriers that make life harder for disabled people. Society faces the challenge of listening to disabled voices, including those of us who rely on PCA services every day, and understanding that PCA care is not optional. It is a lifeline.
Sources:
Munoz, Anabel. “US Department of Justice and Dr. Oz Targeting California over Alleged Medical Fraud.” ABC7 Los Angeles, ABC, 10 Jan. 2026, abc7.com/post/us-department-justice-dr-oz-targeting-california-alleged-medical-fraud/18379958/.
Poli, Domenic. “Two Plead Guilty in Medicaid False Claims Case.” The Recorder, New England Newspapers, Inc., 21 Mar. 2025, https://recorder.com/2025/03/21/two-plead-guilty-in-medicaid-false-claims-case-60150481/.
Raguse, Lou. “Care Recipients Report ‘Collateral Damage’ from Payment Pause during Fraud Audit.” KARE 11, TEGNA Inc., 1 Jan. 2026, https://www.kare11.com/article/news/local/care-recipients-report-collateral-damage-from-payment-pause-during-fraud-audit-mn/89-98b6189a-bacc-4812-9dcf-cfb2c947a69d?