I took a few courses about public policy at my university and met with the groups trying to create change. Did a research paper on this topic even.

The ones in the industry know the secrets and the ones in the government turn a blind eye because lipservice and inspections on paper sound great when you're trying to get votes from older people. They want to believe that when they need care that the providers will be doing the right thing. Sadly, they are not doing the right thing. There's so much money in it when you're charging over $400 per day per patient.

Here's an article that talks about it.

They use nicer words to make it sound less predatory:

Providers have wide latitude in how they utilize MassHealth and other funds, since there are no limits on self-dealing transactions/contracts and no ceiling on administrative costs.

The growth of for-profit ownership in nursing homes, including significant investment by private equity firms and real estate investment trusts, makes it clear that nursing homes are profitable businesses.

A Boston Globe 2014 study of Massachusetts nursing home finances found that many nursing homes directed cash to subsidiaries “…paying million-dollar rental fees and helping to pay executives’ six-figure salaries…”

If you reach out to the authors of that article, including a former state senator, they'd be glad to talk to you about it. They won't remember me though, it's been a while. The things that can be said aloud go way beyond what is written down. No one wants to air their dirty laundry but trust me, the nursing homes are generally given a heads up before inspections take place so nobody gets fined and there are no problems. Unless something changed very, very recently.