Earlier this week we posted a story by Nancy Healey about Medicare fraud. One of our subscribers, Dr. Tom Holohan, has added some of his own observations to the discussion. He is responding below to our question “What is DOGE doing, aside from firing lots of people?”
They are doing what you would expect a group of techie wonks who have no experience with how government actually works and what the employees do on a day-by-day basis. Finding and proving fraud is difficult and time consuming. As an example, in 2023 Medicare staff detected a urinary catheter fraud and subsequently noted:
In early 2023, CMS identified a concerning rise in urinary catheter billings attributed to a small group of 15 Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) supply companies that had recently changed ownership. Through investigative work, CMS determined that people with Medicare did not receive catheters from these DMEPOS companies and were not billed directly, physicians did not order these supplies, and the supplies were not needed…, CMS stopped over 99% of the payments to this small group of potential bad actors before they went out the door, preventing over $4.2 billion in payments as of July 6, 2024. [Source: Urinary Catheter Case Study: CMS’ Swift Action Saves Billions https://www.cms.gov/files/document/cpi-urinary-catheter-case-study.pdf]
A DOGE employee named Sahil Lavingia [whose website sahillavingia.com identifies him as “Founder, Writer, Painter] on May 28, 2025 wrote “DOGE Days”.
On “Day 1” he began looking at contracts of the Department of Veterans Affairs in Washington, D.C. He decided to use an LLM [in AI, a large language model] to flag contracts for cancellation. He did not specify what words or phrases he selected as “flags”, nor how or why they were selected. [The devil is in the details.]
On Day 3, while reviewing reduction-in-force [RIF] efforts, he learned that the “rules” were based on the Veterans Preference Act of 1944 “which surprised me and many others” (!). [Always good to know federal law before you act?]
On Day 5 he stated “I also learned that several of VA’s code repos were already open-source, and the world’s first electronic health record system, VistA, was built by VA employees over 40 years ago.” [This is common knowledge among VHA employees.] He went on to say that “I wondered why there wasn’t a centralized DOGE software engineering playbook with all of our learnings; overall, I was surprised by the lack of knowledge-sharing within DOGE. It seemed like every engineer started from scratch.” [That happens when you don’t know what you’re doing.]
On Day 8, “The reality was setting in: DOGE was more like having McKinsey volunteers embedded in agencies rather than the revolutionary force I’d imagined.” [Yes, reality bites.]
On Day55 “I got the boot from DOGE.” …”My DOGE days were over.” “But I’m also disappointed. I didn’t make any progress on improving the UX of veterans’ filing disability claims or automating/speeding up claims processing… I built several prototypes, but was never able to get approval to ship anything to production that would actually improve American lives–while also saving money for the American taxpayer.”
In the Washington Post (July 16, 2025 p. A13) Lavingia was quoted as having said, in support of AI, “I don’t trust humans with life-and-death tasks.” [Should we assume he is therefore unwilling to have surgery, travel by air, or call 911?]
There you have it. A shambolic futile exercise by actors who naively believed they actually understood the multiple complex functions of the government, and concluded the way to save resources was to fire many employees rather than do the harder work of actually identifying waste and fraud. This is reminiscent of the apocryphal story of a surgeon being asked by his supervisor why he chose to perform a questionable operation, and responding “because that’s the operation I know how to do.”