Pennsylvania’s generous Medicaid personal care program has turned home health assistance into the state’s most common profession, but the system is riddled with vulnerabilities that allow individuals to collect government payments while performing little to no work. Under state rules, elderly or disabled residents can steer Medicaid funds to relatives or friends who assist with daily tasks, with verification managed through a GPS-enabled smartphone app that logs clock-in and clock-out locations.
Surveillance in Harrisburg documented a routine involving Ram Kuma Chhetri, a Bhutanese refugee listed as a home care aide. Records indicated he was working 11 hours a day, seven days a week, generating $82,000 annually in government payments to care for an elderly relative living with 34-year-old Dilu Monger. Months of observation, however, showed Chhetri arriving at the residence, remaining in his vehicle for minutes at a time without entering, and then departing.
The residence associated with the care arrangement showed no outward signs of financial need, recently ranking among the area’s high-value real estate transactions and featuring luxury vehicles in the driveway. When confronted at the home, Monger defended the care schedule but declined to let reporters speak with the client, while noting that state inspections are routinely pre-announced.
Data from the Bureau of Labor Statistics indicates that roughly two percent of Pennsylvanians now work as home health aides, putting the state’s employment rate above all others except New York, California, and Minnesota. State Medicaid home care expenditures climbed from $530 million in 2021 to $850 million three years later. Governor Josh Shapiro’s administration recently advanced pay increases that could further expand the sector.
When approached by reporters outside his home, Chhetri offered conflicting explanations for his daily routine, suggesting he ran errands for the client, though surveillance footage contradicted those claims. Electronic Visit Verification documentation later revealed an even larger overlap: Chhetri was simultaneously billed for a second 77-hour-a-week shift across town caring for a 45-year-old woman named Suk Tamang. GPS logs for that assignment placed clock-ins at Tamang’s residence during times when observers recorded Chhetri elsewhere. According to industry insiders, caregivers frequently bypass location requirements by leaving one phone at home while another is used elsewhere, or by having household members perform punch-ins on their behalf.
Administrative oversight within the agencies handling these accounts has also faced scrutiny. Gaunley Home Care, the agency employing Chhetri, pulls in substantial monthly Medicaid billings from dozens of clients. Biras Adhikari, the owner of Gaunley Home Care, acknowledged that 80 to 85 percent of his business involves relatives caring for family members, creating an environment where clients have little incentive to report absent aides. Adhikari stated that he relies on GPS tracking and quarterly client satisfaction surveys, noting that if clients confirm service is received, agency operators have limited ability to detect discrepancies. He added that he recently accepted Chhetri’s resignation and expressed support for barring family members from serving as paid caregivers to eliminate conflicts of interest.
Further complicating oversight, public records and agency documentation connected several individuals involved in home care administration to overlapping real estate ventures and prior legal issues. Chida Nanda Kafley, whose professional background includes refugee resettlement and home care case management, holds a felony food stamp conviction from 2022 that was later expunged following probation, and works as a realtor alongside Gaunley’s Harrisburg office manager, Deepesh Pradhan. Furthermore, Dilu Monger—whose relative was enrolled under Chhetri’s care—was tasked with reviewing timesheets for the agency, while her husband contracted with firms to train home care aides.
Adhikari stated he was unaware of employee overlaps with client addresses and noted that if internal reviews confirm fraud, contracts would be terminated. However, subsequent checks on Tamang’s residence after a new aide—her stepdaughter—was assigned showed similar patterns where no one entered the home at scheduled clock-in times. Adhikari acknowledged the fundamental challenge of monitoring private residences, stating that eliminating the industry entirely might be the only definitive solution to prevent systemic abuse.
