California has found yet another way to pick the pockets of American taxpayers, and the getaway vehicle is literally an ambulance.

For years, Gov. Gavin Newsom’s (D-CA) California has run a shell game with Medicaid, dressing up a cash grab as if it were legitimate health policy. The scheme is simple once you strip away the bureaucratic fog: California is letting government-run ambulance services stack payment on top of payment for the same single ambulance ride, until taxpayers across the U.S. are footing a bill worth many multiples of what the ride actually costs.