All Aboard the Fraud Train

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Home-based health care is one of the fastest growing segments of the health care industry. According to the United Nations, the number of people over the age of 60 is expected to triple to 2 Billion by 2050. (While this news bodes well for those entrepreneurs looking to jump on the home health care service provider bandwagon, it also presents a huge opportunity for unscrupulous operators to bilk government health care programs through fraudulent claims.) A story reported in the Washington Post details how a married couple from Maryland, who also owned and operated a home health care services company, defrauded the District of Columbia’s Medicaid program out of more than $80 million over the course of seven years. (That’s more than $10 million in government and taxpayer funds disbursed into the wrong hands each year, and that’s just from one company.)

The story states that the scam involved the couple’s relatives who signed up and coached Medicaid recipients. (The beneficiaries received kickbacks for participating in the scheme.) As a result, fraudulent Medicaid claims were submitted for health care services that were never provided. Another interesting fact about this case is that the wife should have been excluded as a Medicaid provider in the first place. It turns out her nursing license was previously revoked in the State of Virginia. (This obviously makes her ineligible to be a Medicaid provider.)

After a four-week trial, the jury deliberated for two days before finding the 52-year-old woman guilty of health care and Medicaid fraud and conspiracy. The jury also found the fraudster’s 63-year-old husband guilty of Medicaid fraud and conspiracy. During the trial, prosecutors described their scheme as a ”money train,” (All aboard!) where the wife was the ”engineer and driver” and the husband served as the ”conductor,” who made ground-level decisions about the day-to-day handling of their conspiracy. (Neither one was particularly good at their job though. They took the wrong track and ended up steering their fraud train onto a collision course with government investigators.)

It looks like this couple will not see the light at the end of the tunnel any time soon. They are facing decades behind bars with the possibility of deportation back to their native country of Cameroon. It looks like they will also have to forfeit $11 million in cash, five luxury vehicles and their home as an immediate start on their restitution payments. (In the meantime, the husband has childcare duty for the couple’s four-year-old twins while the wife is incarcerated.)

Source: Today’s “Fraud of the Day” is based on an article titled, “Federal jury convicts MD. couple in $80 million D.C. Medicaid fraud case,” written by Spencer S. Hsu and published by The Washington Post on Nov. 12, 2015.

A federal jury on Thursday convicted a Bowie, Md., couple of orchestrating a multi-year campaign to defraud D.C. Medicaid of more than $80 million between 2009 and 2014, the largest local health-care fraud scheme ever prosecuted in the city.

After a four-week trial in federal district court in the District, the jury deliberated two days before convicting Florence Bikundi, 52, of four counts of health-care and Medicaid fraud and conspiracy, and her husband, Michael D. Bikundi Sr., 63, of two counts of fraud and conspiracy through her company, Global Health Care Services of the District.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.