Nick Shirley: Fraud is rampant in US elections and healthcare, California’s Medi-Cal budget raises red flags, and organized crime exploits hospice care

Key takeaways

• Fraud is a pervasive issue in the US, impacting various sectors.
• California’s lack of voter ID requirements potentially facilitates election fraud.
• A new task force aims to improve communication between government departments to combat financial fraud.
• California’s Medi-Cal program has seen significant budget growth, raising fraud concerns.
• California’s budget has shifted from a surplus to a significant deficit.
• The complexity of California’s healthcare funding poses challenges to fraud detection.
• Medicare beneficiary numbers are highly valuable to fraudsters.
• Hospice care in California is particularly susceptible to fraud, with organized crime involvement.
• The hospice system’s billing practices make it vulnerable to fraud.
• One third of the hospices in the US are located in LA County, indicating potential oversight issues.
• The concentration of hospices in LA County suggests challenges in healthcare quality.
• Organized crime’s involvement in hospice care highlights systemic vulnerabilities.
• The lack of direct oversight in hospice billing facilitates fraudulent activities.
• Seniors’ Medicare numbers are more valuable to fraudsters than credit cards.
• California’s fiscal health has drastically changed, impacting public services.

Guest intro

Nick Shirley is an independent journalist and YouTuber known for on-the-ground investigations into government fraud. He gained national attention with a December 2025 viral video exposing over $100 million in alleged fraud in Minnesota’s government-funded childcare programs. His latest work uncovers $170 million in suspected daycare and Medi-Cal fraud in California, part of the state’s $222 billion program.

The prevalence of fraud in the US

• There is so much fraud here in the United States it’s unbelievable

  — Nick Shirley

• Fraud affects multiple sectors, including elections and healthcare.
• California’s voter ID laws are seen as a vulnerability for election fraud.

• They’re one of the states that don’t require voter ID so I really just wanna show people how easy it is to vote

  — Nick Shirley

• The lack of voter ID requirements is a critical issue for election integrity.
• Fraud detection efforts are hampered by lack of inter-departmental communication.
• A new task force aims to enhance communication to address financial fraud.

• All these departments inside the government… are now gonna be talking together

  — Nick Shirley

• The task force is expected to lead to increased prosecutions.
• Understanding the scope of fraud is essential for effective policy responses.

California’s healthcare system and fraud vulnerabilities

• California’s Medi-Cal program budget has increased significantly.

• In 2022 they had a $108,000,000,000 go towards Medi-Cal

  — Nick Shirley

• The program’s enrollment has also seen a massive rise.
• The increase in budget and enrollment raises concerns about potential fraud.

• The proposed budget for Medi-Cal is now 222,000,000 and their enrollments 40,000,000

  — Nick Shirley

• The complexity of healthcare funding makes fraud detection challenging.

• They wanna make it so big and so complex that it’s hard to actually crack down on

  — Nick Shirley

• Protecting seniors’ Medicare numbers is crucial due to their high value to fraudsters.
• Medicare beneficiary numbers are more valuable than credit cards to fraudsters.
• Fraudsters target seniors due to the value of their healthcare information.

Financial challenges and implications for public services

• California’s budget has shifted from a surplus to a deficit.

• California at one point is operating a $100,000,000,000 surplus before 2020 now they’re operating in a… $20 to $40,000,000,000 deficit

  — Nick Shirley

• The fiscal changes have implications for public service funding.
• Understanding these changes is crucial for assessing California’s financial health.
• The deficit impacts the state’s ability to provide essential services.
• The shift in budgetary status highlights the need for fiscal accountability.
• California’s financial health is a critical issue in the broader context of state governance.
• The budget deficit underscores the importance of effective financial management.

Hospice care fraud and organized crime involvement

• Significant fraud is occurring in California’s hospice care system.

• There’s thousand percent increase in these hospices Armenia and Russian mafias are running these hospices

  — Nick Shirley

• Organized crime’s involvement highlights systemic vulnerabilities.
• The hospice system allows for billing without direct patient oversight.

• It’s very hard okay so if you do have that medical beneficiary number it’s super easy to make it look like you’re doing stuff

  — Nick Shirley

• The lack of oversight facilitates fraudulent activities.
• One third of the hospices in America are located in LA County.

• One third of the hospices in America are in LA County

  — Nick Shirley

• The concentration of hospices suggests potential oversight issues.
• The distribution of hospices raises questions about healthcare quality in urban areas.
• Addressing hospice care fraud requires targeted policy interventions.