Federal prosecutors said Medicaid fraud has reached “epidemic levels” in the nation’s capital, as they announced charges Thursday against 25 people accused of making claims based on fake symptoms and personal home care that was never performed.
U.S. Attorney Ronald C. Machen Jr. said agents fanned out across the D.C. region to make arrests and seize six luxury vehicles and 49 bank accounts, capping off a multiyear investigation that prosecutors deemed the “largest health care fraud takedown” in the city’s history.
“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.
Authorities are still tabulating the alleged damage, but said one Maryland woman netted $75 million she was not entitled to and that other schemers took in millions more.
The charges, outlined in five federal indictments and local fraud charges, raise new questions about how vulnerable taxpayer-funded health entitlements are to false claims and billing.
About half the states are debating whether to expand Medicaid under President Obama’s health care law, and conservative critics in those states say the federal-state entitlement program’s cost, inefficiency and susceptibility to fraud are reasons to be wary.
Mr. Machen said, that despite the widespread fraud, the problem lay with those engaged in criminal conduct, not with the District’s program itself.
During Thursday’s sweep, agents 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She had been barred from participating in federal health care programs after her nursing license was revoked in Virginia in 2000, but prosecutors accused her of raking in $75 million from the D.C. and Maryland Medicaid programs, anyway, using another name to get back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.
“The fraud was she should have never been in the program,” he said.
Prosecutors said personal health care in private homes is a burgeoning front in Medicaid fraud, and said there have been similar cases out of Miami and Detroit.
Other problems exposed Thursday included corrupt care providers who recruited patients to fake symptoms — walking with a cane and overstating their aches and pains, for example — so they could obtain a prescription for additional care, authorities said.
Prosecutors said those patients received cash payments in exchange for saying they had received home care services. The more fraudulent hours prescribed, the greater the kickback.
Providers then billed Medicaid, completing the fraud.
“They had it down to a science,” Mr. Machen said.