Top prosecutor announces ‘largest health care fraud takedown’ in D.C. history

Top prosecutor announces ‘largest health care fraud takedown’ in D.C. history

The Washington Times

Thursday, February 20, 2014

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In what prosecutors describe as the "largest health care fraud takedown" in D.C. history, 25 people have been charged with bilking the city’s Medicaid program through schemes that mixed exaggerated symptoms and kickbacks with invoices for personal home care that wasn’t performed.

U.S. Attorney Ron Machen said Thursday agents fanned out across the city and surrounding area to make arrests and seize six luxury vehicles and 49 bank accounts, after a multi-year investigation uncovered Medicaid fraud "at epidemic levels."

Authorities also seized the large Maryland home of Florence Bikundi, who owned three home care agencies. She had been barred from participating in federal health care programs after her nursing license was revoked in Virginia in 2000, but prosecutors accused her of raking in $75 million from the D.C. and Maryland Medicaid programs, anyway, using another name to get back into the game.

Mr. Machen said authorities are still tabulating the millions of dollars stolen through another series of schemes, which prosecutors rooted out after a huge spike in personal home care claims from 2006 to 2013.

"We obviously had to look at it, and we uncovered a huge fraud in the process," Mr. Machen said.

Corrupt care providers teamed up with home health care beneficiaries who faked or exaggerated symptoms so they could obtain a prescription for additional care, authorities said. At times, these beneficiaries were coached on how to walk with a cane or describe their aches and pains.

In turn, these beneficiaries received cash payments for attesting that they received home care services — the more fraudulent hours prescribed, the greater the kickback, according to prosecutors.

Providers then billed Medicaid for these "services," completing the fraud.

"They had it down to a science," Mr. Machen said.

The alleged fraud is likely to raise new questions about safeguards against fraud among health entitlements such as Medicaid, which is funded by state and federal tax dollars.

Mr. Machen cast the issue as a burgeoning sector of corruption across the country, from Detroit to Miami, although Thursday’s indictments focused on the nation’s capital.

"An astonishing amount of money was stolen from the American taxpayer," said Valerie Parlave, assistant director in charge of the FBI’s Washington Field Office.

The investigation relied on undercover work and cooperating witnesses, which should serve as a warning to potential fraudsters, according to Mr. Machen.

"The next person you recruit into your scheme may be an undercover agent," he said. "The next phone call you make to recruit a bogus Medicaid beneficiary may be a recorded phone call by law enforcement."

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