To Catch A Fraudster: Watch Us Bust A Refugee Medicaid Scammer Red-Handed

HARRISBURG, Pa. — Ram Kuma Chhetri has a routine.

Every morning at 6 a.m., he pulls into the driveway of a nearby home, sits in the car for two or three minutes, then leaves. At 5 p.m., he does the same: drives up, fiddles with his phone in the driver’s seat, then returns home.

Why does he do this every day?

Pennsylvania allows poor elderly people to steer government Medicaid payments to their relatives or friends for helping them cook, clean and perform other everyday in-home tasks. Its version of the program is so generous that home care is now the most common profession in the state. A “home care” aide only has to do one thing to get the state to pay out: use a GPS-enabled phone app that confirms that the worker is at his client’s house when he clocks in and clocks out.

To anyone checking the system, Chhetri, a Bhutanese refugee, appears to be working 11 hours a day, seven days a week caring for an elderly person, work that unleashes $82,000 in government payments. In reality, he seems to spend five minutes a day in her driveway.

The Daily Wire amassed months of footage of Chhetri doing this like clockwork. As he left one afternoon, he gave me a smile and wave before lighting up a cigarette as he piloted his electric car at the turtle-like pace of a man with nothing to do.

No-show “home care” work is so common in Pennsylvania that it’s no longer viewed as something to hide. In August, the federal Drug Enforcement Administration arrested a drug trafficker in the state who asked the agents to let him out of handcuffs so he could clock out of the home health shift he was supposedly working. When they pointed out that that was illegal, he seemed confused, saying, “Everyone is doing this. If this is a problem, you’ll have to arrest the whole city.”

But even arresting the whole city may not stop the fraud: One home health care scam was being operated from a prison.

The home Chhetri visits hardly seems to need taxpayer-funded help. It was one of the most expensive real estate transactions in the area in the month it was sold. The residents appear to drive a Range Rover and a custom-painted Tesla Cybertruck.

One weekday afternoon, The Daily Wire knocked on the door and was greeted by the homeowner, 34-year-old Dilu Monger. Monger, who was home with her children, said her aunt lives with her and receives 11 hours of home health care a day, from 6 a.m. to 5 p.m.

It was 4:50 p.m., but Monger wouldn’t let me see Chhetri or the aunt. She seemed confused that anyone would try to verify in person: she said the government inspector calls ahead to let her know when she’ll be coming by.

Pre-announced inspections, of course, defeat the purpose. They allow Pennsylvania to cast rampant fraud as impossible, while actually enabling it. That could be why two percent of all Pennsylvanians now work as home health aides, according to the Bureau of Labor Statistics – a higher rate than every state but New York, California, and Minnesota. The state’s Medicaid home care spending grew from $530 million in 2021 to $850 million three years later.

I’d previously tailed Chhetri to see where he went after his driveway pit stops, and found he returned to his house a mile away. So, turned away by Monger, I went there and arrived just as he was walking from his front door to his car. Confronted with footage of his drive-thrus, Chhetri seemed at a loss for words. His daughter, who was with him, spoke up.

“Sometimes he just goes and does it,” she conceded, but other times he spends time at the house, she said. She said the client is not disabled, but has diabetes.

Chhetri eventually sputtered that he sometimes leaves his client’s home to go shopping for her. But that obviously isn’t what he’s been doing. The videos show he consistently pulls in the driveway moments before 5 p.m., then leaves without so much as opening his car door. If he had just gotten groceries, he doesn’t give them to his client in the afternoon — or the next morning, when he also pulls in and leaves without exiting the vehicle.

Scenes like this play out every day in the 33 states whose Medicaid programs bill the federal government for “personal services” – the technical term for a program that, unlike traditional “home health” provided by nurses, enables payments to family members with no medical training but plenty of conflict of interest.

Yet it is especially common in the community of Bhutanese refugees centered in Pennsylvania and Ohio. Efforts to make the system harder to game have been met with resistance from those profiting on it, who invoke arguments about privacy or freedom. One Ohio lawmaker proposed “breadcrumb” tracking, which would report the GPS location of aides throughout a shift. But it was stripped from the fraud bill that secured bipartisan passage.

Even had the provision passed, home care aides have no shortage of workarounds. One Bhutanese immigrant in Harrisburg told me that many times, “The caregiver leaves one phone at home and takes another phone with them. Someone who stayed at the home simply clocks in and out for them on the app. They still get paid while doing absolutely nothing.” If the aide lives with the client, GPS fails off the bat.

“The home care agencies” — for-profit companies that bill Medicaid and pay the aides — ”are fully aware that the caregivers aren’t working, but they help them do it anyway because they are in on the scam,” he said.

Easy money and luxury lives

At 77 hours a week, the federal and state governments are paying about $82,600 a year for one refugee to watch a friend with diabetes. The rate Pennsylvania pays per hour has averaged $20.63 in recent years. (The company typically keeps about a quarter of the hourly pay, not counting overtime.) It’s more lucrative than that sounds because it’s easy to work more than 40 hours when the “job” is spending time at home with family.

In Pennsylvania, the state sets the threshold for “elderly” at only 60 years old, and some poor families seek to enroll a family member, even if they aren’t particularly infirm, simply to draw a paycheck. Democrat Governor Josh Shapiro this summer set a pay raise in motion that could soon incentivize even more people to join a lifestyle that is already surprisingly comfortable.

While the United States government pays $80,000 a year to watch Monger’s aunt so she doesn’t have to, Monger lives a jet-setting life of luxury and pageantry. Her family makes frequent trips to Nepal, where a round trip ticket costs $2,000. Social media shows her frequently luxuriating in places like Aruba and Disney World.

It’s clear that the Chhetri and Monger families are relatives or close friends. And the older lady frequently pictured with Chhetri, presumably her aunt, isn’t exactly homebound. Here she is at the Hershey Park amusement park–with Chhetri, this time, tagging along:

“There is no way for us to find out,” home care boss says – “that’s the lawmakers’ job”

When The Daily Wire confronted Chettri on August 14, he said he is employed by Gaunley Home Care, which, according to Medicaid records, pulls in about $150,000 a month from 25 clients. It is owned by a fellow Bhutanese man named Biras Adhikari.

Adhikari in a phone interview said that just three days after I confronted Chhetri, he resigned from the company without explanation.

He acknowledged major shortcomings in the system, even if he believes he’s doing “everything right.” To guard against fraud, he said, home care companies rely on GPS systems and quarterly check-ins with clients about their satisfaction. But he said 100% of his business comes from Medicaid and 80 to 85% is people taking care of their own relatives, which creates a situation where clients are unlikely to report the aide for not showing up or doing little.

“If we are doing everything right on our side, like punch-in and punch-out from the location and submitting the timesheet, and the client is saying they are receiving the service and everything, there is no way for us to find out,” Adhikari said. “I think that’s the lawmakers’ job to find those loopholes and try to prevent it,”

His solution would be to require home aides to be randomly assigned strangers, not family members.

“What government should do, they should eliminate the family caregivers,” he said. “I would support that.”

If an elderly person knew a stranger would be dispatched to cook and clean, she’d only tell a doctor she was unable to do those things if it was the truth, rather than because she wanted a paycheck for her unemployed son, he explained. And if that person didn’t show up, “on [the] quarterly quality survey you don’t lie, you know?,” Adhikari said.

But is that enough? Or are home health companies themselves in on it? It turns out it was worse than it seemed.

Layers of fraud

Adhikari provided me with Ram Chhetri’s Electronic Visit Verification documentation – the GPS reports the government relies on to determine whether an aide is where he’s supposed to be. They showed that Chhetri was billing the government for watching a different client across town during the same hours that both Monger and Chhetri told me he was paid to watch her aunt. That would mean he was clocking into two 77-hour-a-week jobs at the same time, which would bring his total pay to $160,000 a year. In reality, he almost certainly wasn’t going to either — his car could typically be seen outside his own house during the day.

The GPS paperwork documenting his shifts for his other client, a 45-year old woman named Suk Tamang, showed that the clock-in was performed from the coordinates of Tamang’s house–even though I know he wasn’t there because I was watching him across town at those exact moments. The simplest explanation is that Chhetri left a phone tied to his account at her house, and Tamang clocked in and out for him.

Tamang would, of course, know that her aide wasn’t showing up, yet she never told anyone. And whatever the 45-year old had told a doctor to make him believe she couldn’t survive without a taxpayer-funded aide was apparently false, because she was, in fact, doing just that.

The GPS reports include a phone number for the client – the only way the government could contact Tamang, short of going to their house. But it isn’t actually her phone number: It belongs to a felon convicted of welfare fraud who is tied to a top Gaunley official.

The bio of Chida Nanda Kafley says he worked in “refugee resettlement” and that “since 2013, Chida has served as a Case Manager/Area Manager in home care.” That’s even though, according to public records, in 2022 he was convicted of felony food stamp fraud. (After serving one year probation, prosecutors removed the felony conviction in a program called Accelerated Rehabilitative Disposition.) Simultaneous to all that, he works as a realtor for Ghimire Homes, a nearly all-Bhutanese real estate agency.

That makes him a colleague of the man who runs Gaunley Home Care’s Harrisburg office, Deepesh Pradhan. Adhikari, the company’s owner, lives in Ohio where he holds other jobs, but even his man on the ground, Pradhan, dispenses hundreds of thousands of Medicaid dollars as a side gig, while working at Ghimire Homes.

The Daily Wire called and texted the phone number, but no one answered, and its voice mail was full.

Adhikari told me he’d send his staff to interview Suk Tamang, and if they proved that she lied about Chhetri’s presence, he’d terminate her as a client.

I was shocked to find out the name of the Gaunley official tasked with policing timesheets: Dilu Monger, the very person whose aunt was the other client Chhetri was pretending to take care of.

Monger’s husband, Roshan Bhai, is in charge of training home care aides in Harrisburg, working as a contractor for Gaunley and other firms.

Adhikari told me he didn’t realize that the address I flagged for him belonged to two of his employees. He said Gaunley has never had a client at Monger’s address, so if Chhetri is clocking in for a shift there, as both Chhetri and Monger indicated to me that he was, the aunt must be enrolled with another home care firm.

Dilu Monger and her husband did not respond to inquiries.

“If Dilu is involved I think they should be prosecuted. I’ll support that 100%. I’ll be ready to give all the information from my agency because personally, I’m not involved in all of this, like what my staff does,” Adhikari said.

Adhikari acknowledged that the fact that the GPS report shows Chhetri clocking at Suk Tamang’s house, despite definitively not being there, means he can’t be sure that any of the aides are actually working.

“I”m very confused myself,” Adhikari said. “Maybe the state can implement more rules for our agencies… Give us tools that we can determine if our employees are actually the ones who are punching in and punching out.”

But the inherent difficulty of monitoring what goes on in private homes means it may be impossible to come up with tracking systems that fraudsters won’t quickly find ways to evade.

Adhikari said after Chhetri quit, his firm sent a new aide to take care of Tamang. I captured footage of the house this week and found that no one entered at clock-in time. Adhikari said the new aide is Tamang’s stepdaughter who lives with her–highlighting a situation where most verification becomes moot, even if the relative isn’t actually performing any services.

I asked Adhikari whether it’s possible that the only solution may be to end his industry.

“I think they can do that too,” Adhikari said.