Every government form I sign contains some variation of the same warning: “I certify that the information provided is true and correct.” “False statements may result in civil penalties.” “Federal charges may apply.”
I have been signing forms like that since Ronald Reagan was president.
Americans do not need another report telling them what everyone already knows. They need accountability.
For 40 years, I have managed a medical catastrophe. My wife has endured nearly 100 surgeries, multiple amputations, years of hospitalization, and enough insurance claims and medical bills to wallpaper a house. Over those four decades, I learned something millions of family caregivers understand all too well: You don’t respect what you don’t inspect.
Long before smartphones, electronic records, and artificial intelligence, I sat at kitchen tables with a pencil, a calculator, and a telephone, combing through Explanation of Benefits forms, hospital bills, physician statements, pharmacy charges, and insurance claims. I have argued with surgeons, hospital administrators, insurance executives, case managers, billing departments, and just about everyone in between. I have won all but two of those arguments because if I did not, my wife paid the price. The consequences of their mistakes landed in my living room.
When your loved one’s health and financial survival hang in the balance, you learn to confront, challenge, and stay in the room long after everyone else wishes you would leave. That is what advocates do. That is what skin in the game looks like.
Imagine if our elected advocates approached their responsibilities with even a fraction of that urgency.
As America approaches its 250th birthday, we are preparing celebrations, restoring monuments, and planning fireworks displays. That’s fine. I enjoy fireworks as much as anyone. But the colonists did not risk everything over fireworks. The Stamp Act was never merely about stamps. It was about accountability. It was about whether government could impose burdens on citizens while remaining insulated from the consequences of those burdens.
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Two hundred and 50 years later, that question remains painfully relevant.
More than 65 million Americans serve as family caregivers. Together, they provide an estimated $1.2 trillion in unpaid care each year. They keep loved ones out of institutions, reduce burdens on taxpayers, and shoulder responsibilities that would overwhelm many public systems. We do not have lobbyists. We do not have communications directors. We have kitchen tables covered with bills. We have loved ones whose lives depend on us showing up again tomorrow.
Then, we turn on the news. We see stories of fraud. We see agencies unable to account for money. We see programs consuming billions with little to show for it but waste. We see officials preside over failure and retire comfortably while ordinary Americans are left holding the bill.
In “The Dark Knight,” the Joker tells Batman, “It’s all part of the plan.” After enough years of watching obvious failures produce little accountability, cynicism begins to sound less like paranoia and more like experience.
Finding fraud matters. But merely finding it is not enough.
If I discovered an error in a medical bill and nobody corrected it, the problem remained. If I identified the source of a problem and nobody addressed it, all I had really done was document my frustration. At some point, discovery without consequence becomes theater.
Americans have watched report after report, audit after audit, investigation after investigation. Fraud was found. Good. Now what?
Finding fraud is important. Arresting fraudsters is important. But accountability also requires asking who ignored it, who enabled it, who benefited from it, and who failed to stop it.
And if those people occupied positions of authority, what consequences do they face? Loss of office? Loss of contracts? Public accountability? Criminal prosecution where warranted? Or do they simply move on while the public absorbs the cost?
Otherwise, we’re not fixing a system. We’re simply rotating villains.
The average American lives under penalty of perjury. Every form I sign reminds me of it. If I knowingly misrepresent information, consequences follow. Why should the people entrusted with billions of taxpayer dollars operate under a lower standard than the citizens paying the bills?
If fraud occurred, prosecute the people responsible and name names. If someone knowingly violated the public trust, identify him and hold him accountable. Not for revenge. For stewardship.
I write this while undergoing cancer treatment. At the same time, I am still caring for a woman who has spent four decades battling catastrophic disability. If I sound impatient with waste, fraud, and excuses, it is because I have spent too much of my life paying for other people’s mistakes.
Millions of caregivers know exactly what I mean. We are tired in a way that is difficult to explain to people who have never lived this life. Staying outraged takes more energy than most caregivers can afford. But we are paying attention.
Scripture says, “When the righteous increase, the people rejoice, but when the wicked rule, the people groan” (Proverbs 29:2).
There is a lot of groaning in this country. I hear it in hospital waiting rooms. I hear it in caregiver support groups. I hear it from people staring at medical bills long after midnight.
Americans do not need another report telling them what everyone already knows. They need accountability. They need leaders willing to impose upon government the same standards government imposes upon them.
For too long, the consequences of government failure have been borne by the wrong people. It is time for accountability to land somewhere else.
Recent primary elections across the country have confirmed the end of bipartisanship in the United States — and the destruction of the uniparty that has ruled Washington since the early 1980s.
Both major parties’ congressional establishments are crumbling. Prominent, once-popular legislators and governors are falling to upstart socialists in Democratic primaries and to Trump-endorsed MAGA candidates in Republican contests.
The old bipartisan order blurred responsibility. Polarization reveals who stands for what.
This is the most important and positive change in American politics in decades. Bipartisanship is no longer possible. Polarization now defines American politics.
Contrary to what the media and establishment figures keep insisting, that is not necessarily a bad thing.
Two genuinely divergent political parties in Washington can serve the American people better than a cartel of polite agreement. Strong, fundamental disagreement keeps politicians from doing too much, too quickly, with too little scrutiny.
That is how the founders designed the system to work. They did not want easy majorities imposing their will on everyone else. They built a constitutional order full of friction, checks, divided powers, and obstacles to sudden national action.
Bipartisanship, by contrast, gets things done. That is often the problem.
When Washington becomes “effective,” it usually means politicians, powerful interests, and armies of professional grifters have found a way to expand spending for their mutual benefit. The public pays. The insiders profit. The press calls it “responsible governing.”
We see this across federal programs, from Medicaid to food stamps to defense spending. Fraud, chicanery, and outright theft flourish when both parties decide the money must keep flowing. The late Department of Government Efficiency began to expose some of the grift. It did not last long.
That is what bipartisanship often produces: waste, theft, and punishment for the people who expose it.
Polarization interferes with the trade of public money for political power. For everyone except thieves and grifters, that is a benefit.
Fortunately, American politics is now undergoing a thorough bifurcation.
The Democratic Party is nominating more open socialists at every level of government. They are winning in places such as New York City and Seattle and taking office. Republicans, for their part, are giving landslide primary victories to candidates endorsed by President Trump.
These events mark the end of the old bipartisan arrangement. The two parties are moving to opposite corners of the ring. The middle has grown thin.
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Democrats have made their stand as the party of open socialism. Sen. Bernie Sanders (I-Vt.), Sen. Elizabeth Warren (D-Mass.), California Gov. Gavin Newsom, Rep. Alexandria Ocasio-Cortez (D-N.Y.), and her fellow Squad members call for vastly expanded government power and direct attacks on speech, enterprise, and excellence. Their politics increasingly divide Americans by race, sex, and class in pursuit of a utopian vision.
Their party tested many of these ideas during the pandemic and the racial upheavals of the past decade. We know they mean it. Republicans who assisted in those efforts are now being cast out of office as their terms expire — or are leaving before primary voters come for them.
Republicans, meanwhile, have coalesced around Trump’s MAGA movement, a call to restore American greatness through freedom and the rule of law. Trump, Vice President JD Vance, House Speaker Mike Johnson (R-La.), and Secretary of State Marco Rubio represent this vision. It seeks to unleash human excellence while dismantling the destructive concentrations of power built over the past century.
The two elements of the MAGA strategy — freedom and government retrenchment — reflect the two poles of the founders’ vision of ordered liberty. That creates some tension inside the movement. MAGA partisans must sometimes use government power to break up the crony system government helped build. More liberty-minded Republicans understandably find that uncomfortable, necessary though it may be.
Democrats struggled with their own internal split. For now, the hard-left democratic socialists have won. That is the real reason for today’s polarization: The party of the left has moved farther to the fringe.
The only thing both parties still agree on is that they cannot stop overspending. Even there, they overspend for different reasons. Democrats emphasize social programs. Republicans emphasize national defense and the border.
The current gridlock in Congress, with major legislation stalled in the Senate because of the filibuster, is not the fault of polarization. The Republican Senate majority could pass much of its agenda by eliminating the filibuster. It has chosen not to do so.
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The country needs major federal reform, especially a large reduction in spending. Polarization is not the obstacle to that work. It is the beginning of clarity.
The old bipartisan order blurred responsibility. Polarization reveals who stands for what. Eventually, the American people will decide which vision they prefer.
That bifurcation gives voters clearer choices between parties, within parties, and among candidates. It is becoming much more obvious what citizens are voting for when they support either side.
As cities such as Detroit, Los Angeles, Seattle, and Portland deteriorate into hellscapes while their most capable residents move to Dallas, Nashville, Charlotte, Miami, and other places with lower taxes, less crime, and lighter regulation, the consequences of these rival political visions grow harder to ignore.
Political polarization is the source of that clarity. It is the one thing that can restore true self-government to the American people.
It’s been almost two months since President Trump took the bold step of officially forming the Task Force to Eliminate Fraud.
Since then, we have already uncovered tens of billions of dollars in defrauded taxpayer money, prosecuted dozens of fraudsters, and stopped billions in suspicious payments.
And we’re just getting started.
If you are defrauding the American taxpayer, we will find you and take you to court.
Our success raises an obvious question: Why has it taken the federal government until now to finally tackle fraud? Because Federal Trade Commission Chairman Andrew Ferguson and I are taking a new approach.
Until President Trump’s inauguration, federal anti-fraud efforts have been defined by a “pay-and-chase” approach: Federal agencies like the Health and Human Services issue payments and then only take steps to identify fraud on the back end. The federal government might prosecute the alleged fraudsters — but only if the fraud is big enough.
It’s a flawed approach that has been predictably exploited. Every year, the United States loses about $250 billion to fraud but recovers only about $10 billion. Put plainly, “pay and chase” does nothing to actually stop fraud.
Our new approach starts with close coordination. We are orchestrating all federal agencies’ anti-fraud efforts from the White House. Rather than haphazard fraud mitigation, the task force is focusing agencies’ efforts on target programs where spending is high but anti-fraud protections are low. Using this approach, we are already uncovering major fraud scandals across a range of federal programs.
Kelly Loeffler at the Small Business Administration has referred $22 billion in fraudulent loans for collection. At the Department of Education, Linda McMahon has identified $1 billion in fraudulent student loans from “ghost students.” Brooke Rollins at the Department of Agriculture has identified 14,000 luxury-car owners receiving SNAP benefits in just one state.
We aren’t just identifying these fraudsters. We are ramping up federal prosecutions against them as well — not just because American taxpayers deserve justice, but because active enforcement holds fraudsters accountable and deters fraud in the first place.
Our message is simple: No fraud is too big or too small to prosecute. If you are defrauding the American taxpayer, we will find you and take you to court.
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To do so, we established a new Fraud Division at the Department of Justice led by Assistant Attorney General Colin McDonald.
In just the last two months, the division has executed 22 search warrants against fraudulent day-care centers in Minnesota, including the Quality Learing Center. It has also launched a major crackdown in Los Angeles against Medicare fraudsters who stole over $50 million and secured multiyear prison sentences against fraudsters in a $522 million health care scheme.
All across the country, fraudsters have been put on notice.
We are also ordering states to hold up their end of the bargain and prosecute fraudsters in the federal programs they oversee. We have sent letters to the governors in all 50 states instructing them to use their existing resources to identify and prosecute fraudsters in the Medicaid program.
Alongside aggressive prosecution, the task force is preventing fraud before taxpayer money leaves the federal government. Agencies will now release funds only when they are confident that a payment is legitimate and lawful.
As a result, Trump administration agencies are now establishing fraud indicators and analyzing data to detect patterns of fraud — things like unreasonable growth, impossible services, and other hallmarks of fraud. When an unacceptable risk of fraud is identified, the money stops.
We’re seeing this approach pay dividends already in one of the biggest federal programs: Medicare.
Dr. Mehmet Oz has identified nearly 800 suspected fraudulent providers of hospice and home health care services and withheld payment for their questionable services. So far, we have saved $1.4 billion in potentially fraudulent payments and have paused enrollment of additional providers.
This is an approach that works and will be scaled to other federal programs. The days of “pay and chase” are over. It’s time to prevent and prosecute.
Editor's note: This op-ed was adapted from an X post by Vice President JD Vance.
Vice President JD Vance, who chairs the Task Force to Eliminate Fraud, announced on Wednesday the first major steps to compel states to crack down on Medicaid fraud nationwide.
During a press conference Wednesday on anti-fraud initiatives, Vance declared that the Trump administration would be “very aggressively” encouraging states to take fraud concerns more seriously.
'So these letters are the first step, the first effort to try to force these states to get serious about prosecuting fraud.'
He explained that the U.S. Medicaid system is run like 50 separate systems.
“The federal government pays most of the Medicaid money, but then each of the individual states actually administers the Medicaid program,” Vance stated.
Despite the federal government generously funding Medicaid Fraud Control Units, responsible for detecting and eliminating fraud, some states are not using them, Vance stated. He highlighted his point by providing examples.
Vance stated that Hawaii, a state that has received billions of taxpayers’ dollars through the Medicaid system, had not made a single fraud conviction or indictment “over the last few years.”
“That means that if you’re committing fraud in Medicaid in Hawaii, at least up until now — hopefully now they’re going to take it seriously — you have had effectively free rein from the government of Hawaii to commit as much fraud as you want,” Vance stated. “That is a complete disgrace.”
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Vance explained that New York, which has a $100 billion Medicaid program, has had only nine indictments over the last year.
The vice president compared New York, a Democratic-led state, to Indiana, a Republican-led state. He noted that despite Indiana having only a third of New York’s population, it has pursued more than four times as many indictments during the same period.
Vance stated that the federal government is withholding $1.3 billion in Medicaid reimbursements to California. He said that the state has “not taken fraud very seriously,” resulting in California and American taxpayers being defrauded.
Vance announced that 50 state Medicaid programs would be receiving a letter requiring them to demonstrate that they are “effectively and aggressively prosecuting” fraud. If they fail to do so, their anti-fraud units will no longer receive federal funds.
“We encourage people to work with us. We want to help you use technology and other tools to get rid of the fraud, to get to the root of the fraud. We want to help you,” Vance stated. “But we can only help these state programs if those state programs are willing to help themselves. So these letters are the first step, the first effort to try to force these states to get serious about prosecuting fraud.”
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Will the public sector ever come to grips with the scale of the problem?
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