Largest DC healthcare fraud takedown busts 25

Law enforcement agents arrested 25 people in the Washington, D.C., region after investigations into Medicaid home healthcare billings. The arrests marked the largest healthcare fraud bust in D.C. history, with losses estimated at tens of millions of dollars, the FBI's Washington Field Office announced Thursday.

Arrestees included home care and nursing staff agency operators and personal care assistants. Federal and local law enforcement agents seized six luxury vehicles, a Maryland home and 49 bank accounts in connection with the cases.

Among the fraud schemes uncovered, Florence Bikundi, an owner of three home care agencies who was debarred from participating in federal health insurance programs, allegedly collected $75 million from Medicaid in the district and Maryland. Charges against her included multiple counts of money laundering for the way she allegedly hid the nature, source and location of illegal proceeds.

Agents also accused providers of offering kickbacks to beneficiaries to fake or exaggerate health symptoms to qualify for home care benefits. Beneficiaries reportedly signed timesheets stating they received home care when they didn't, according to the FBI announcement. And a personal care aide has been accused of healthcare fraud and aggravated identity theft for allegedly selling counterfeit home health care aide certificates.

Authorities opened the investigations after seeing a dramatic rise in home care claims from 2006 to 2013, The Washington Times reported. In 2006, 2,500 beneficiaries billed the district's Medicaid program for $40 million in personal care services. By 2013, 10,000 beneficiaries billed for $280 million, according to The Washington Post.

"This investigation has revealed that Medicaid fraud in the District of Columbia is at epidemic levels," said U.S. Attorney Ronald C. Machen in the announcement.

That statement also may be true elsewhere, since the D.C. charges follow news that the Centers for Medicare & Medicaid Services stopped taking new applications for home care providers in several fraud zones--Dallas; Detroit; Houston; and Fort Lauderdale, Fla.--as FierceHealthPayer previously reported. The charges have also called into question the prudence of Medicaid expansion under the Affordable Care Act, given the program's fraud vulnerability, the Times noted.    

For more:
- here's the announcement
- read the Washington Times article
- see the Washington Post article

Suggested Articles

A judge has dismissed the ongoing case between Oscar Health and Blue Cross Blue Shield of Florida over broker arrangements.

On-demand doctor house call app Heal is expanding its services into the New York City market with the acquisition of Doctors on Call.

Expanding options for dental care in Medicare is a popular idea, but policymakers could take several avenues toward this goal, a new analysis shows.