What Profoundd reviewed: Luke Rosiak's two posts on X, from screenshots; his full Daily Wire article; and the eight-minute Daily Wire video that his first post shares, which Profoundd transcribed. Video quotations come from that transcription.
The claims, checked
- "Home care" has quickly become the "most common job in blue states": Confirmed. In the Bureau of Labor Statistics' May 2025 estimates, home health and personal care aides are the largest job category in 10 states, up from six in May 2019: California, Connecticut, Maine, Massachusetts, Minnesota, New Jersey, New Mexico, New York, Pennsylvania and Wisconsin. All 10 have Democratic governors. Taken together, the states Kamala Harris won in 2024 have 2.6 million aide jobs, more than any other occupation; in the states with Republican governors, aides are 1.69% of jobs and rank ninth. Nationally, aides are now the largest job category, with 4.31 million jobs. Not every Democratic-led state fits: aides rank fifth in Illinois and second in Washington state, and California and New York alone hold 63% of the aide jobs in the states Harris won.
- "This video shows why: Because people are billing Medicaid $80k+ a year for work that they aren't actually doing": The billing is documented; how much of the job growth it explains is not measured. In August, federal and state prosecutors charged 19 defendants in eastern Pennsylvania over home care that, they allege, was billed but never given; one aide allegedly claimed more than 24 hours of care in a single day on over 1,100 occasions, costing Medicaid more than $1.2 million. Nationally, the Health and Human Services inspector general reports that in fiscal 2025 "significantly more convictions for fraud involved personal care services attendants than any other provider type." The Daily Wire's $82,600 is its own arithmetic for one aide. The other side: Pennsylvania's home care trade group says the growth reflects demand from an aging population, and the state reports 20% more adults in its home care programs since 2018; Pennsylvania's aide jobs rose 40% from 2019 to 2025, a rough comparison, since the periods differ and aide jobs include private-pay and Medicare work. Neither the state nor the federal government publishes an estimate of how many Pennsylvania home care hours are billed but not worked.
- "Watch this refugee pull into a driveway for 2 minutes each day to trick the GPS anti-fraud system": Supported by the Daily Wire's footage and the records it describes; no charges are reported. The clips Profoundd checked show a car pulling into a suburban driveway near 6 a.m. and 5 p.m. on dates from June 30 to Aug. 11. Federal law has the visit-verification system record "the location of service delivery" and "the time the service begins and ends," so a stop at those two moments satisfies it. The aide's employer gave Rosiak visit records that, the article says, also clocked the aide in at a second client's house across town while Rosiak was watching him elsewhere. The aide's daughter conceded that "Sometimes he just goes and does it," the article says, though she said that at other times he stays; the aide said he sometimes leaves to shop for the client. His employer said he resigned three days after Rosiak confronted him.
- "Gov. Josh Shapiro has made PA the epicenter of home care fraud": A judgment whose core holds in part. Since May 2022, the last federal survey before he took office, Pennsylvania's aide jobs grew 32.7%, against 22.9% nationally, growth that fits rising demand as well as fraud. In August, federal prosecutors expanded a health care fraud strike force to Philadelphia, saying eastern Pennsylvania had "Recently" become "the target of fraudsters" in home care. As attorney general in 2020, Shapiro said "it's possible, no, likely" that Pennsylvania was losing $3 billion a year to fraud, a congressional committee quoted him in a letter this year. "The" epicenter is not shown: the Justice Department has also expanded its strike force program to Minnesota, Massachusetts, Northern California, Arizona and Nevada. Shapiro calls Pennsylvania "a national leader in stopping fraud," citing prosecutions; the state's fraud unit, ranked No. 1 nationally in criminal convictions in fiscal 2025, is run by the separately elected Republican attorney general, Dave Sunday.
- "setting the threshold for elderly at only 60": The line exists, but it is the federal aging-services line, and it is not what opens Medicaid home care. Pennsylvania's aging programs use 60, and so does Shapiro's 2024 aging plan; the federal Older Americans Act defines an "older individual" as one "60 years of age or older." Medicaid home care in Pennsylvania has no age-60 gate: Community HealthChoices is open from age 21 to anyone whose assessment and physician certify a need for nursing-home-level care and who meets its financial test. The Medicaid "Aging Waiver" it replaced did use 60, according to a state page archived in January 2022, before Shapiro took office. The core of Rosiak's concern, that people who are not very infirm get enrolled, goes to that need test: in his case, the aide's daughter told Rosiak the client is not disabled but has diabetes.
- "permitting up to 24 hours of care a day–$175k for providing" companionship: Holds in substance. In a 2024 Commonwealth Court case, a 69-year-old woman had been approved "for 168 PAS hours per week, i.e., 24 hours per day, 7 days per week," with her daughter and granddaughter, who lived with her, giving the care; at the $20.63 rate the Daily Wire uses, that is about $180,000 a year. Even her plan's reduced 126-hour schedule set aside 49.7 hours a week for her "Health and Safety," time that "does not encompass any ADLs or IADLs," the state's administrative law judge wrote, meaning no daily tasks such as bathing or housework. For comparison, a federal wage rule defines "companionship services" to include being "present with the person in his or her home." The court restored all 168 hours. The 24-hour approval dates from April 2021, before Shapiro; the old Aging Waiver page said "There is no cap on the services," and Shapiro's administration runs the program today. The other side of the same record: the woman was "fully reliant on others for bed mobility," and the court wrote that "there is no record evidence that Patient can remain unassisted for six hours per day."
- "Read how the state helps refugees get away with scamming the feds": The oversight gaps are partly documented; the refugee concentration is Rosiak's own finding, which Profoundd did not check. The visit check looks only at clock-in and clock-out, by federal design. Care coordinators must check in at least every three months, and in person at least twice a year, according to a July presentation by the program's three managed-care plans; the homeowner told Rosiak the inspector calls ahead. The industry's trade group has urged the state to catch "impossible scheduling conflicts and overlapping service patterns at the time services are scheduled," the pattern in Rosiak's case. The federal government pays 57.41% of most Pennsylvania Medicaid service costs this fiscal year. The state says it uses electronic visit verification and ongoing monitoring and refers suspected fraud to the attorney general.
Disclosure: this article was researched and drafted by Claude, an AI model made by Anthropic, and reviewed before release. Profoundd is not naming the aide, the family he worked for or the agency's staff, because the Daily Wire does not report that any of them has been charged.
What the Daily Wire found in Harrisburg
Rosiak's article, published Oct. 30, follows a Bhutanese refugee who works as a home care aide near Harrisburg. "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," the article says, and he returns at 5 p.m. to do the same. On paper, Rosiak writes, the aide works 11 hours a day, seven days a week, for an older woman living in that house, which at Pennsylvania's rate "unleashes $82,000 in government payments." The video says the Daily Wire watched him "over the course of three months"; the time-stamped clips Profoundd checked are dated June 30 to Aug. 11. The 77 hours a week come from the homeowner, who told Rosiak her aunt receives care from 6 a.m. to 5 p.m. daily. The $20.63 rate is the figure the Pennsylvania Homecare Association, the industry's trade group, gives for the state's Medicaid rate.
Rosiak reports that the aide's daughter partly confirmed the pattern. She "conceded" that "Sometimes he just goes and does it," the article says, though she said that at other times he spends time at the house, and that the client is not disabled but has diabetes. The aide said he sometimes leaves the client's home to shop for her. The homeowner declined to let Rosiak see the aide or her aunt, and said the government inspector calls ahead before visiting. Profoundd has not confirmed with the state whether visits are announced in advance.
The owner of the agency that employed the aide spoke to Rosiak on the record. He said 100% of his business comes from Medicaid and that 80% to 85% of it is people caring for their own relatives. "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," he said. "What government should do, they should eliminate the family caregivers." The visit records he gave Rosiak showed the aide clocking in for a second client across town during the same hours, which would mean two 77-hour-a-week jobs at once. The clock-in "was performed from the coordinates of [the client's] house–even though I know he wasn't there because I was watching him across town at those exact moments," Rosiak writes. "I'm very confused myself," the owner said. "Give us tools that we can determine if our employees are actually the ones who are punching in and punching out."
The article adds that the homeowner is the agency's own official "tasked with policing timesheets." The owner said his agency has never had a client at her address, so her aunt's care must be billed through another firm. He said the aide resigned three days after the Daily Wire confronted him; the aide who replaced him at the second client is that client's stepdaughter, who lives with her, and Rosiak writes that footage he shot in late October found "no one entered at clock-in time." Rosiak says he reported the case to the federal Fraud.gov site.
The jobs numbers
The Bureau of Labor Statistics' May 2025 occupational survey, the most recent, counts 4,305,810 home health and personal care aide jobs nationwide. That is more than retail salespersons (3,897,860) and fast food and counter workers (3,854,050), the next two. The survey counts jobs, not people, and leaves out the self-employed. Nationally, aides' median pay is $17.21 an hour. In May 2019 aides were the largest occupation in six states; by May 2025, in ten. Across the 19 states Harris won plus Washington, D.C., aides make up 3.90% of jobs; across the states with Republican governors, 1.69%. Within the Democratic-led group the pattern is not uniform: aides rank fifth in Illinois and second in Washington state.
Pennsylvania has 257,370 aide jobs, up from 193,930 in May 2022 and 183,430 in May 2019. They are about 4.2% of all jobs in the state and the largest occupation there. Measured against population, as the Daily Wire does, that is 1.97% of residents, using the Census Bureau's 2024 estimate. Only New York (3.34%), California (2.46%) and Minnesota (2.22%) are higher, so the article's statement that the rate is "higher than every state but New York, California, and Minnesota" checks out.
The two explanations for that growth can be tested only in part. The demand explanation is the industry's: "Higher utilization and greater claims volume are the result of increased demand for home-based care and should not be confused with a greater incidence of fraud," the Homecare Association said in August. The Department of Human Services told Fox News that the number of adults in its home care programs has risen 20% since 2018, about half the 40% rise in Pennsylvania aide jobs from 2019 to 2025. That comparison is rough: aide jobs also include private-pay and Medicare work, and more hours per client add jobs too. Rosiak's explanation is fraud, and the prosecutions show it happens, but neither Pennsylvania nor the federal government publishes an estimate of how many of the state's home care hours are billed but not worked. The federal inspector general has audited samples of personal care claims in other states, such as Missouri; Profoundd found no such audit of Pennsylvania's program in a search of the inspector general's reports on Nov. 1.
Rosiak's article also says "The state's Medicaid home care spending grew from $530 million in 2021 to $850 million three years later." It gives no source, and Profoundd has not matched the figure to a published dataset. One candidate is the provider-level Medicaid spending data the Department of Health and Human Services released in February 2026, but that file lists providers by ID number without their states, so Profoundd could not total it for Pennsylvania in time for this story. In August, Fox News reported that the Justice Department put Pennsylvania's Medicaid home care spending at $8 billion, so the article's figure appears to cover something narrower.
What Pennsylvania's rules say
Most older Pennsylvanians who get Medicaid-paid help at home get it through Community HealthChoices, a managed-care program run by private insurance plans. Its home care waiver requires an applicant to be "At least 21 years old" and "Nursing Facility Clinically Eligible," meaning a physician certifies that, without help with daily activities, the person would need a nursing home. An assessor from the local Area Agency on Aging does the functional evaluation, according to a February 2026 guide from the Pennsylvania Health Law Project, a legal aid group.
The age-60 line in Rosiak's post is real in Pennsylvania's aging programs. The Department of Human Services' page for the Medicaid "Aging Waiver," as archived in January 2022, described a "Home and Community-Based Services Waiver for Individuals Ages 60 and Older" that had already "Transitioned to Community HealthChoices." Shapiro took office in January 2023. The state's OPTIONS program, which helps residents stay at home, serves those "age 60 and older," and the administration's 2024 aging plan counts "Pennsylvanians aged 60 and over." The same line appears in the federal Older Americans Act, which funds aging services nationwide and defines an "older individual" as "an individual who is 60 years of age or older."
Round-the-clock care is allowed. The archived Aging Waiver page said "There is no cap on the services that Aging Waiver participants receive." In Cruz v. Department of Human Services, decided in December 2024, the Commonwealth Court described a woman with a long list of diagnoses who had been approved in 2021 "for 168 PAS hours per week, i.e., 24 hours per day, 7 days per week." Her daughter and granddaughter, who lived with her, provided the care. Her plan, UPMC, cut the hours to 126 a week. Even that schedule allotted 49.7 hours for her "Health and Safety," which "does not encompass any ADLs or IADLs," the department's administrative law judge wrote, and the judge called the daughter's overnight help "kind and loving" but "not ADLs." The judge also found the daughter's testimony "not credible" and upheld the cut, as did the department's Bureau of Hearings and Appeals in April 2023.
The Commonwealth Court reversed. The only "evidence" for the cut, it said, was a UPMC supervisor's testimony that the hours are "intended for physical health needs only," and not for when "the participant is sleeping, because that would be considered supervision." The woman's assessment showed she was "fully reliant on others for bed mobility," and "there is no record evidence that Patient can remain unassisted for six hours per day," the court wrote, sending the case back "for the reinstatement of Patient's 168 PAS hours per week." The opinion is non-precedential.
The state's federally approved waiver, as quoted in the case, provides the hours "for hands-on assistance" with daily activities "such as eating, bathing, dressing, and personal hygiene," and says help with housework "must not comprise the majority of the PAS hours." It also says the hours "are to be used when informal supports such as other household members are not available." For comparison, Profoundd notes that a federal wage-and-hour rule, written for a different purpose, defines "companionship services" as "fellowship" and "protection," meaning "to be present with the person in his or her home." On the state's visit-verification page, a separate "Companion" service appears only under its programs for people with intellectual disabilities and autism. Rosiak's video describes what aides do as "cooking, cleaning, and companionship."
Enforcement, and what each side says
On Aug. 4 the Justice Department expanded its Northeast Health Care Fraud Strike Force to Philadelphia and, with the U.S. attorney and Pennsylvania's attorney general, announced charges against 19 defendants over schemes involving more than $4 million in claims to Medicare and Medicaid. "Recently, the Eastern District of Pennsylvania has become the target of fraudsters seeking to take advantage of Medicaid's home care funds," the department said. "Home care fraud is everywhere, and the victim is all of us taxpayers. Medicaid claims data and the experience of veteran prosecutors all point to the systematic exploitation of reimbursable home care programs," said David Metcalf, the U.S. attorney in Philadelphia. The cases include aides who allegedly billed while in prison, in the hospital, driving for a rideshare company or abroad, and a recipient who claimed to need dozens of hours of help while working construction. The department has also expanded its strike force program to Minnesota, Massachusetts, Northern California, Arizona and Nevada.
Pennsylvania's Medicaid Fraud Control Section, run by Republican Attorney General Dave Sunday, ranked No. 1 nationally in criminal convictions in federal fiscal 2025, with convictions in 115 cases, according to the federal inspector general's annual report as announced by Sunday's office; the section also prosecutes abuse and neglect. The Homecare Association cites the ranking as proof of enforcement. In March, the House Energy and Commerce Committee asked Shapiro and Human Services Secretary Val Arkoosh for their program-integrity records by March 17, citing the state's fraud cases. Its letter quotes Shapiro telling a 2020 news conference, as attorney general, that "it's possible, no, likely, that Pennsylvania is losing $3 billion a year to fraud." Profoundd did not check whether the administration answered the committee.
Shapiro's side is that the state catches fraud. "Here in Pennsylvania, we combat fraud wherever we find it. In 2024, we charged 119 cases of Medicaid fraud — recovering more than $11 million for taxpayers," Shapiro said in a statement Fox News quoted in August. His spokeswoman, Rosie Lapowsky, told Fox that the Department of Human Services brought one of the cases charged in August to the Justice Department, "clearly showing our system works," and said the state's large number of home care providers is not by itself a sign of fraud. The department said it uses electronic visit verification and ongoing monitoring, and refers suspected fraud to Sunday's office. Its rules say home care "claims submitted without a matching EVV visit will be denied," a check the aide's clock-ins at the second client would have passed, because the records place them at that client's house.
The industry's own trade group calls the state's visit-verification program "one of the nation's strongest," with "a minimum compliance requirement of 85%," and wants it used "more proactively": to "identify impossible scheduling conflicts and overlapping service patterns at the time services are scheduled," the Homecare Association said in August, "Rather than relying primarily on post-payment audits months or years later." An aide clocked in at two clients at once is the kind of overlap it describes. Profoundd has not seen the state's answer on whether its system flags one.
On pay, Rosiak writes that Shapiro "this summer set a pay raise in motion that could soon incentivize even more people" to take up the work, linking to a Fox43 story headlined "Home health nurses given pay bump in state budget, direct care nurses left out." The 2026-27 budget signed this summer "included a boost in funding to increase the rates paid for some home health visits," the Altoona Mirror reported in July. "Home care workers employed by agencies were left out and the 2026-27 budget didn't help much either," it added, referring to the 2025-26 budget, which put $21 million into raising pay by $1 to $5 an hour for about 8,500 aides hired directly by the people they care for, according to the Department of Human Services. Agency-employed aides, like the one in Rosiak's story, got neither raise.
The refugee question
Rosiak writes that scenes like the Harrisburg one "play out every day" in states that bill Medicaid for personal care, "Yet it is especially common in the community of Bhutanese refugees centered in Pennsylvania and Ohio." His video adds that "The majority of the millions spent on home health around Harrisburg goes to companies owned by people with Bhutanese names," and cites "census figures" on Bhutanese residents on Medicaid. Neither the article nor the video shows the data or method behind those claims, and Profoundd did not check them. An unnamed Bhutanese immigrant in Harrisburg told Rosiak that some aides leave a second phone at the client's home so someone there can clock in and out for them. At a House task force hearing in June, the Daily Wire reported, Rep. Brandon Gill asked Rosiak whether "hundreds of companies, and 100%" he had examined "had names of a Somali, Bhutanese, or other sort of an African origin," and Rosiak answered, "Correct." He also said that "Refugees are using [Medicaid] to bring money back to their home countries."
Rosiak's critics say this kind of focus is unfair. Before his Senate testimony in May, the NAACP, the National Immigration Law Center and the National Urban League wrote that he "mischaracterized a Medicaid homecare service providing long-term care support to family caregivers as fraudulent while primarily focusing attention on non-white program participants." Citing a Georgetown University analysis, they noted that of those sentenced for health care fraud in 2024, "45% were white"; that figure covers all health care fraud, not home care. In Ohio, after CMS Administrator Mehmet Oz called Columbus "a hub with Nepalese and Bhutanese populations" at a federal fraud announcement and the state suspended 47 central Ohio providers, Bhutanese American Sudarshan Pyakurel told NBC4 that officials "need to prosecute an individual, not the whole community."
Questions Profoundd would put to the Shapiro administration
These questions have not been sent. Profoundd would ask the Department of Human Services: Are home visits announced in advance, and does anyone make unannounced visits when fraud is suspected? Does the state's visit-verification system flag one aide clocked in at two clients at once, or an aide billing an implausible number of hours in a week? Which standard applies, the department's "will be denied" or the 85% compliance minimum the industry describes, and how many claims were denied in 2025? How many people are authorized for 24 hours a day of care, and how many of those are cared for by relatives? Did the department receive or act on the Daily Wire's evidence? Did it answer the House committee? And does Shapiro still stand by his 2020 estimate of $3 billion a year lost to fraud?
Profoundd would ask the Daily Wire for the source of its $530 million to $850 million figure, its census figure on Bhutanese residents, and its method for counting Bhutanese-owned agencies.
Profoundd's read
Rosiak's central case is specific and on camera: an aide who, on the Daily Wire's footage and the employer records it describes, was paid for long shifts he does not appear to have worked. The record beyond that case supports much of his broader concern. Aides are now the largest job category in the country and in 10 states, all led by Democrats, up from six states in 2019. Pennsylvania's aide jobs have grown faster than the nation's since the last survey before Shapiro took office, though that fits rising demand as well as fraud. Federal and state prosecutors are charging no-show home care billing in Pennsylvania, and the industry's own trade group wants the state to use its visit data "more proactively" to catch impossible schedules before it pays. As attorney general, Shapiro himself said it was "possible, no, likely" that Pennsylvania was losing $3 billion a year to fraud.
The posts go further than the evidence in three places. The age-60 line is the ordinary federal one for aging services, and it does not open Medicaid home care, which starts at 21 for anyone who meets the nursing-home need test. Round-the-clock care is real, and in the one 24-hour case Profoundd found on record much of it paid for presence rather than tasks, but that was for a woman who could not move in bed on her own. And "the" epicenter is not shown: federal strike forces have gone to five other states as well, and no published estimate says how much of the job growth is fraud; the state's enrollment figure, a rough match at best, has grown more slowly than aide jobs. The refugee angle rests on one case and on Rosiak's own analysis of agency owners, which his article and video do not show.
What Profoundd could not verify
- Whether the aide in the video was, in fact, absent for the hours billed. Profoundd has seen the Daily Wire's edited clips, not its full footage or the visit records.
- Whether Pennsylvania inspectors announce visits in advance. That comes from the homeowner's account to the Daily Wire.
- The source of the Daily Wire's $530 million and $850 million figures, its census figure on Bhutanese residents, and its count of Bhutanese-owned agencies. Profoundd did not check the Census Bureau's Bhutanese population tables, and the federal provider-level Medicaid data does not list providers' states.
- Several other video claims that are not in the posts: that the program costs "$35 billion a year," that New York paid bills lacking GPS confirmation, and that the pay is tax-free and does not count against food stamps.
Profoundd did not ask the Shapiro administration, the Department of Human Services, the agency or the Daily Wire for comment before publication.
