Medicaid Fraud Bust

WASHINGTON (CBSDC/AP) — Federal authorities say 25 people have been charged in a wide-ranging scheme to obtain millions of dollars in fraudulent Medicaid payments from the District of Columbia government.

U.S. Attorney Ronald Machen calls it the largest health-care fraud case in the city’s history. It involved bogus claims for home care services, a category of Medicaid claim that has grown dramatically in the city over the past eight years. Machen says fraud is largely responsible for the increase in those claims. The uptick in billings for home care — from $40 million in 2006 to $280 million last year — was part of what tipped off authorities to illegal activity, U.S. Attorney Ronald Machen said.

“We concluded that much of the growth was due to aggressive networks of fraudsters paying kickbacks to beneficiaries to manufacture false claims for nonexistent services,” Machen said, later adding: “Medicaid fraud in the District of Columbia is at epidemic levels.”

Among those charged Thursday was Florence Bikundi, 51, of Bowie, Md., the owner of a home care agency in suburban Maryland who had lost her nursing license and was ineligible to receive Medicaid payments. Authorities say that by using different names, she was able to bill the city for $75 million in Medicaid payments.

Prosecutors say many of the defendants persuaded patients to fake illness or injury so they could bill Medicaid for home care they didn’t receive. Some of those patients received kickbacks, authorities said, although no patients have been charged.

Read: Medicaid Fraud Release

Machen said it wasn’t clear whether any of those payments went to legitimate home care services, but Bikundi was able to amass significant personal wealth, authorities said. Among the property seized from her were millions of dollars from 46 bank accounts, a 7,300-square-foot home valued at $927,000 and five luxury vehicles.

No attorney was listed in court records for Bikundi, who is in custody, and no one answered a call to her home Thursday afternoon.

Machen said there wasn’t any particular weakness in the district’s Medicaid program that made it vulnerable to bogus claims, and he noted that similar schemes have been perpetrated in other cities, including Detroit and Miami. The investigation is ongoing, and authorities said it was impossible to put a dollar amount on the fraudulent billings, although the indictments not involving Bikundi outlined schemes valued at less than $500,000.

“These numbers could likely grow. This is what we know so far,” Machen said.

A dozen people were charged in five federal indictments that were unsealed Thursday. Thirteen others were charged with fraud in D.C. Superior Court. All but three were in custody Thursday afternoon, authorities said.

Many of those charged are immigrants from Cameroon in west Africa, but authorities did not go into detail about their nationalities.

US Attorney: fraud, kickbacks, false billings revealed in “largest health care fraud takedown in DC history;” in one scheme, $75M collected. — Matt DelSignore WNEW (@mattdelsignore) February 20, 2014

Seized in investigation: 49 bank accounts, a house, six vehicles. Machen: Medicaid fraud in DC is at “epidemic levels.” Twenty-five charged. — Matt DelSignore WNEW (@mattdelsignore) February 20, 2014

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