Let’s discuss waste, fraud and abuse

Dean Lerner

During his interminable State of the Union address, President Trump included reference to waste, fraud and abuse. Of course, such mention was opportunistically political, containing recurrent condemnations of the Somali community, a favorite target of our President’s vile rhetoric. While waste, fraud and abuse is a worthy topic and should be condemned and eliminated, perhaps a more introspective approach would have better served our nation.

The New York Times recently reported that “[s]tarting in early August [2025], nursing home executives began making donations that would eventually total nearly $4.8 million to MAGA, Inc., a super PAC devoted to President Trump and run by his allies.” After these donations, the Trump Administration revoked the rule requiring more nursing home staff.

Over 46,500 comments and years of research and study led to this rule being finalized by the Centers for Medicare and Medicaid Services in 2024.  

The nursing home industry did its best to upend the rule during the rulemaking process, but when it failed in this effort it launched multiple attacks on different fronts: legal, political and otherwise.

Staffing, no one will be surprised, is the single most important factor in nursing home care, and is known to protect and improve the lives of over 1.24 million residents who make their home in Medicare- and Medicaid-certified facilities. Staffing is also known to be insufficient, often grossly insufficient, in an unimaginable number of homes. Research shows a direct correlation between poor staffing and poor care. Neglect and abuse are all too common in understaffed facilities. Among other designs, the rule was researched to save at least 13,000 lives annually.

The American Health Care Association represents thousands of member nursing homes in this mostly for-profit industry funded by untold billions of taxpayer dollars. Private equity ownership, Real Estate Investment Trusts, related party transactions and other organizational schemes are known to rob caregiving for profiteering. The AHCA is one of the most powerful lobbying organizations in our country, and was perhaps the most powerful of the forces dedicated to crushing the rule. It even filed a lawsuit in Texas attacking the rule.  

Member nursing homes pay millions of dollars in dues to the AHCA, and are then reimbursed by taxpayer dollars as an allowable expense. The 2024 Form 990 Non-Profit tax return of the AHCA details $24,250,918 in Membership Dues Revenue. The President and CEO during this time reported his salary and benefits of $2,411,285. It is unknown as of yet what the new President and CEO, Clifton J. Porter II, will earn from his efforts. However, we do know that he “...has been recognized as one of this year’s Top Lobbyists by The Hill, a prestigious award among Washington, D.C., lobbyists and industry leaders."

Truth be known, AHCA’s interests/objectives are twofold: 1. More taxpayer money with no accountability, and 2. Less regulation. It seems more than incongruous that we taxpayers should support any organization whose interests are in direct conflict with the health, safety, welfare and rights interests of the residents of the nursing homes they represent.    

In the interests of transparency and curbing waste, fraud and abuse, perhaps President Trump will share the substance of his conversations with the nursing home executives who so generously donated to his MAGA, Inc. super PAC. Quid pro quo comes to mind. In addition, perhaps he will instruct his administration to prohibit the AHCA and other such associations from receiving a single penny of taxpayer money. Now, that would be worthy of the thunderous applause and adoration he so desperately craves.

Dean Lerner is a graduate of Grinnell College and Drake University Law School. He served for nearly 30 years as an Iowa Assistant Attorney General, Chief Deputy Secretary of State, then Deputy/Director of the Iowa Department of Inspections & Appeals. He then worked for the CMS Director of the Division of Nursing Homes and the United States Attorney for the Northern District of Iowa.