I want to walk through one of the best-documented examples of memetic warfare, because the mechanics matter more than the politics. The pattern is the same regardless of the target, and anyone who writes about accountability needs the tools to recognize it.

The case: Maria Ressa

Maria Ressa is a Filipino-American journalist who co-founded Rappler, a digital newsroom in the Philippines that began reporting on the Duterte administration’s drug-war killings and the social-media infrastructure that protected them from political consequences. In 2021, she shared the Nobel Peace Prize with Russian journalist Dmitry Muratov “for their efforts to safeguard freedom of expression.”

What’s relevant to this analysis is what happened to her in between. After Rappler published its 2016 investigation into the network of paid trolls, sock-puppet accounts, and bot-amplified messaging that the Duterte campaign and government had been using, the same machinery turned on Ressa personally. Researchers at the International Center for Journalists (ICFJ), working with Rappler, later analyzed more than 450,000 social-media posts directed at her between 2016 and 2021. Their finding: roughly sixty percent of the abuse was not about her reporting at all. It was designed to damage her credibility — to make her radioactive as a source. In the month after Rappler’s exposé, she was averaging about ninety hate messages an hour.

Ressa and her team gave this tactic a name: “patriotic trolling” — state-sponsored online harassment dressed up as grassroots citizen outrage. The trolls were not random. Reporting and subsequent investigations have tied much of the coordination to a Philippine government communications office, with assists from political consultants whose names will be familiar to anyone who followed the 2016 U.S. election cycle.

The campaign worked, in the narrow sense the operators cared about. Ressa was charged with cyber-libel and tax evasion. Rappler’s operating license was challenged. She faced the real possibility of prison. Many of her sources stopped talking to her. Some of her former colleagues began repeating the trolls’ framing back to her in private, then in public. The Nobel committee, in effect, validated her reporting before her own country’s courts did.

What memetic warfare actually is

It is useful to separate three things people often blur together.

Disinformation is false content. Propaganda is persuasive content produced on behalf of a power. Memetic warfare is the delivery system — the use of viral cultural units (a phrase, an image, a recurring insult) to move a narrative through ordinary human social behavior faster than the truth can catch up. The genius, from the attacker’s perspective, is that the network does most of the work. The operators only have to seed the meme, amplify it during the critical early hours, and let identification do the rest. Each person who shares believes they are simply telling the truth as they see it. Many of them are.

This is why memetic warfare is so effective against accountability figures specifically. Accountability work depends on a baseline of credibility — the assumption that, if you say something happened, it is worth checking. Strip the credibility, and the work becomes invisible whether or not it is correct. The target does not have to be discredited; she only has to be made tiring.

The pattern, in plainer terms

Reading across Ressa’s case and the academic literature that has followed it, a few signals show up repeatedly. None of them, by themselves, prove coordination — but together they are a recognizable signature.

The volume comes from nowhere and arrives all at once. A target who has been writing about a politically sensitive subject for years suddenly experiences a surge of attacks across multiple platforms within hours of a specific piece. The accounts driving the surge are not, on inspection, organic readers; they include freshly created profiles, accounts with no posting history outside the campaign, and a small number of high-reach hubs that the smaller accounts amplify.

The framing is personal rather than substantive. The attacks rarely engage with the underlying claim. Instead they go after the target’s character, mental state, family, finances, or sexuality. This is the tell: a campaign concerned with truth would argue about facts. A campaign concerned with reach goes after the source.

The narrative is recyclable. The same phrase — “discredited,” “unhinged,” “paid by,” “everyone knows” — surfaces across accounts that do not appear to know each other. Two years later, a reporter who has never heard of the campaign will type the target’s name into a search bar and find the phrase staring back.

The institutional response lags. Platforms, prosecutors, and editors are slow to react because each individual post is, in isolation, defensible as opinion. The coordinated effect is illegible to systems that adjudicate one post at a time.

Why this matters for governance writing

The reason to know all of this is not to play counter-insurgency online. It is to read public information correctly.

If you are a citizen trying to evaluate a regulator, a legislator, a public integrity official, or a journalist, you will, at some point, encounter a confident assertion that the person is corrupt, crazy, or compromised. The assertion may be true. It may also be the visible output of a campaign whose operators are uninterested in whether it is true. The ability to tell the difference is now part of basic civic literacy.

A few practical habits help. Read the underlying work, not the commentary about the work. When you encounter a damning characterization, ask whether you can locate its origin — and whether the people repeating it appear to have. Treat a sudden, coordinated flood of identical phrasing as data about the campaign, not about the target. And give serious weight to formal accountability findings (Nobel committees, inspectors general, courts of appeal, peer-reviewed analyses) over volume on a platform — while recognizing that those institutions can themselves be slow and imperfect.

Ressa’s own warning, which she has repeated in venues from Harvard to her 2022 memoir How to Stand Up to a Dictator, is the part most worth carrying away: the techniques developed against her in Manila were not contained to Manila. They have been adapted, exported, and applied at every level of governance where someone with a record is in the way of someone with a platform. The defense, such as it is, runs through the reader.

Memetic warfare wins when we trust the meme more than the work. The work is harder. It is also still where the truth tends to be.

Sarah Unsicker is a former Missouri legislator who writes about policy and legislative craft from the concept to the courtroom.

Sources

• Nobel Peace Prize, Maria Ressa Facts: https://www.nobelprize.org/prizes/peace/2021/ressa/facts/

• ICFJ / Rappler big-data study of online violence against Maria Ressa (March 2021): https://www.icfj.org/our-work/maria-ressa-big-data-analysis

• “State-led and coordinated: ICFJ dives into online attacks vs Maria Ressa” (Rappler): https://www.rappler.com/world/global-affairs/icfj-case-study-online-violence-maria-ressa-march-2021/

• Columbia Journalism Review, “Targeted by Duterte”: https://www.cjr.org/60th/targeted-by-duterte-philippines-maria-ressa.php

• Harvard Gazette, Ressa on authoritarians and disinformation (2021): https://news.harvard.edu/gazette/story/2021/11/maria-ressa-warns-of-authoritarians-social-media-disinformation/

• Yale Law School, “Maria Ressa Ruminates on the Dangers of Disinformation”: https://law.yale.edu/yls-today/news/maria-ressa-ruminates-dangers-disinformation

• Maria Ressa, How to Stand Up to a Dictator (HarperCollins, 2022)

The Medicaid Director Demands States Tackle Fraud

News, as presented on TV, often ignores the decades of policy work behind the headlines. It may be difficult, even for astute consumers, to understand Fox News’ recent reporting, that “Dr. Oz puts all 50 governors on notice over billions lost to Medicaid fraud,” as anything other than a former Oprah TV star punishing every state for Minnesota’s Feeding our Future scandal, in which dozens of people laundered pandemic-era food relief funds. This reading couldn’t be further from the truth. The April 23 letters are the most recent action in a decades-long, bipartisan effort to address provider-side fraud—and they signal the federal government’s intent to move from planning to implementation.

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Dr. Mehmet Oz, a cardio-thoracic surgeon who was a professor at Columbia Medical School, leads the Centers for Medicare and Medicaid Services (CMS) within the Department of Health and Human Services (HHS), which has one of the largest budgets in the entire federal government. He signed the letters personally.

Medicaid is second only to education in states’ line-item budget spending, and total Medicaid spending in 2023 reached over $900 billion. This alone makes Medicaid an attractive target for criminals, although the complexity of the system makes such fraud hard to pull off for your average bank robber. Two months ago, the Financial Crimes Enforcement Network of the U.S. Treasury (FinCEN) released an advisory to banks, warning of fraudsters, including transnational criminal organizations, laundering taxpayer money from welfare fraud.

Medicaid Fraud Explained

In 2005, the federal government identified “program integrity” within Medicaid as a priority for reducing the federal deficit. Included in the Deficit Reduction Act of 2005 was encouragement for states to recover false and fraudulent claims (Sec. 6031). It set up a Medicaid Integrity Program within CMS to review and audit Medicaid providers to reduce fraud, waste and abuse (Sec. 6034).

Discussion about Medicaid Fraud is often about participant fraud, not provider fraud. As a result, the concept of “fighting fraud in Medicaid” gets connected to the idea of people losing access to healthcare. The federal government is pushing states to shift their focus to providers who are billing for services not provided, which has been documented since at least 2005. The HHS Office of Inspector General (HHS-OIG) Criminal Enforcement Actions for 2005 looks remarkably similar to today’s docket. One physical therapist was ordered to pay nearly $1 million in restitution for billing services not performed, using unlicensed technicians without supervision, and paying referral kickbacks. A separate home health case involved billing for non-homebound and non-medically-necessary services. Two decades later, the categories of fraud are unchanged; the scale is not.

The Biden administration, in 2021, released a National Strategy on Countering Corruption. Every good strategy requires planning and implementation. The planning stage happened under the Biden administration. Implementation is happening under Trump.

The Letters Demand Planning and Implementation

On April 23, 2026 CMS sent letters to all 50 states and to state Medicaid directors, demanding they cut the flow of money to providers and nonprofits who profit from fraudulent billing practices. These letters were accompanied by a video on CMS’s Twitter/X Account that indicated that more enforcement is coming. These letters demand states immediately share their own planning phase related to Medicaid provider fraud, and they are consistent with the federal government’s implementation of the US Strategy on Countering Corruption. The letter to governors contains an implied threat, that “failure to do so will be considered as we evaluate the likelihood of fraud in each state moving forward.”

At the same time as the governors’ letters, a uniform letter was sent to state Medicaid directors, formally requesting, pursuant to CMS’ oversight responsibilities and state plan obligations, that each state submit a two-year provider revalidation strategy. Within 10 days of the letter, states must signal intent and the plans as they exist, or their intent to develop plans. Within 30 days, Medicaid directors are asked to provide a comprehensive strategy for re-evaluating high-risk Medicaid providers within two years. Once the revalidation is completed, CMS wants the results. That will allow them to cross-check between states.

Reading the Quiet Part

Medicaid recipients will appreciate that besides revalidation, the first paragraph of the letter also addresses provider directory validation. Patients’ frustration with a lack of accurate directory information is real, and it is a burden on both patients and the Medicaid system itself.

The letters specifically call out providers who do not have a National Provider Identification Number (NPI); and a provider’s lack of an NPI is a genuine red flag. However, some small businesses, especially HCBS providers (Home and Community Based Services, often a service provided for individuals with significant disabilities), may have let this slip through the cracks. Protecting good-faith providers who fail to perform administrative obligations is a natural tension in fraud-prevention effort in a system as complex as Medicaid.

In summary, CMS is moving in a consistent direction with regard to the age-old theme of “fighting corruption, fraud, waste, and abuse.” This carries forward anti-corruption priorities announced under the Biden Administration. The threat is real: states’ non-cooperation risks a targeted analysis by the federal government. The enforcement effort deserves support—and careful watching to ensure it lands on the criminal actors it’s meant to reach, not on the small honest providers who keep Medicaid running.

—Sarah Unsicker is a former Missouri legislator who writes about policy and legislative craft from the concept to the courtroom.

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