The This is Real podcast series, which was originally published in May of 2018, is being highlighted in honor of National Law Enforcement Appreciation Day on January 9th. Listen in and learn more about how our law enforcement agents root out fraud, waste and abuse within federal heath care programs.
Welcome to This is Real, a podcast series produced by the Department of Health and Human Services Office of Inspector General.
I'm Todd Silver, and in our last episode, we dove into the investigation of Florence Bikundi and her home health care company, Global Healthcare.
[Curtis: "She should've never been involved in the health care system at all because HHS-OIG, 10 years previous to this, had excluded her. So, it just, it intrigued me from that point on - how did this individual get into the system and re-enter the program?"]
In this episode, we're going to go into how far Florence Bikundi went to conceal her scheme, and the extent to which she spent the money she stole from you and me.
Florence Igwacho, which is Florence Bikundi's maiden name, had her nursing license revoked in 1999. The next year the agency excluded her from participating in all federal health care programs.
However, she was able to conceal her past and get back into the system using her married name.
Once she was in, she carried out a massive health care fraud scheme, billing millions to Medicaid for personal home health services that were not fully provided to Medicaid beneficiaries.
The case against Florence Bikundi took years to develop, but the investigation started to take shape when Agent began interviewing the "so-called" patients.
[Curtis: "Where you start to get mad, where you start to see things that bother you is when you start to go and interview patients. And you go and you knock on the door and somebody answers the door that looks healthier than you do. And you start to ask them about why they have home health care, and they start to tell you about high blood pressure."]
Agent Curtis even describes an instance where he went to visit a patient who was supposedly receiving home health care, and the patient wasn't even home!
Later, Agent Curtis received a call from this "home-bound" patient while he was at work - at a home improvement store.
[Curtis: "It's mind-boggling to think."]
The more patients Agent Curtis interviewed, the more he realized that the bulk of Global's patients did not need home health care.
Global didn't want patients who needed home health care, because they'd have to take care of them. The company only wanted patients who had an active Medicaid card through whom they could bill Medicaid.
This is a big problem, because you have a company billing Medicaid for services that were not provided, and now these services may not be available to people who really need this care.
Although Agent Curtis could never prove that Global denied patients who needed home health care, he has seen cases where this kind of behavior has real consequences.
[Curtis: "I have investigated abuse and neglect in the District of Columbia of an individual that was shot - it was a young kid - who was shot and was a quadriplegic. When you're quadriplegic you have to have somebody assist you in moving so you don't get ulcers or sores on your, on normally your buttocks and your back. This kid couldn't get a legitimate company to take care of him because he's too much work, and it's too dangerous. This kid actually died from having open sores on his back get infected and, and that actually took his life because of this type of care."]
Let's take a step back and identify the players in this scheme.
Bikundi's the mastermind, the beneficiaries are in cahoots with the patient recruiters and the personal care attendants.
Agent Curtis believes that Bikundi's family is also involved, namely her husband, her son, and two of her sisters.
But the one outstanding question is, what about the doctors?
According to Agent Curtis, the doctors' signatures are crucial in a scheme like this because, whether they're complicit or not, that signature verifies that the patient needs this care.
If Global didn't get that doctor's signature? They wouldn't get a dime from Medicaid.
[Music fade in]
The problem was that the doctors refused to sign a prescription for unnecessary home health care for their patients.
But that didn't stop Bikundi. She turned this problem into a party. A signing party to be exact…
[Curtis: "They would have signing parties and Florence would send one particular employee out to buy, in her words, 'special pens,' to do this. And then, buy them pizza. And they would sit all night long, forging District of Columbia medical professionals' - mainly doctors' - signatures."]
During these signing parties, Bikundi also directed her staff to forge legitimate plans of care.
So this is what they'd do: they'd take real plans of care, they'd cut out the doctor's signature, then they'd glue it to a new fraudulent plan of care, and then they'd photocopy it to make it look legitimate…
[Curtis: "…and then that was what they would turn in to Medicaid. So, they were quite masterful at document forgery at Global Healthcare."
[Music fade out]
Todd: "You said that they had these parties late at night when some of the other staff were gone, so there were actually other staff who thought this was a legitimate business?"
Curtis: "Yes. So there was the inside group, and then there was all the other, all the other people. They weren't necessarily aware of the in-depth crimes which were going on. Now, those people provided great information when we interviewed them on what their job was and what they were told they were supposed to be doing. So we could prove Florence Bikundi knew the Right from the Wrong through interviewing these people."]
One employee in particular was the key to the investigation.
[Music fade in]
The Director of Quality Assurance at Global provided intricate details - the dates, the times, the receipts, the "special pens," and it all pointed to Florence Bikundi.
[Curtis: "He sunk the ship for them. He was the linchpin to Florence. He knew everything, and it all lined up with the evidence. So it put it right in Florence Bikundi's lap."]
You may recall that Agent Curtis described this case as going down one rabbit hole after another, and each one added more evidence, more suspects, and more money.
The case could have gone on for many more years, but he says at some point you have to finish the investigation and take it to the prosecutor.
That isn't easy.
Special Agents LOVE working these complex cases, where every day they uncover something new.
The more evidence they uncover, the stronger their case. And that's exactly what the prosecutors are looking for.
That's why they work closely with prosecutors when developing the case.
The prosecutors help the agents determine - among other things - when to go to Medicaid officials with the evidence and tell them to stop reimbursing this fraudulent company.
I mean, you have cut off the money at some point and go after the bad guys, right?
[Curtis: "You want to be very judicious in how you use that administrative authority. That is a very tough decision, because, what if they were a legitimate operating place, and we just shut them down? So you really try to go through your investigation to make sure you have a credible allegation of fraud before you shut someone's payments down."]
This is where the danger of health care fraud comes into play.
In the Bikundi case, a suspect was making millions of dollars from a fraudulent scheme.
But she may also be involved in other criminal activities - things that the investigators may not even know about - drug diversion, identity theft, organized crime. You name it.
[Curtis: We don't just do administrative stuff. We come in, we put criminal cases together, and we come with an arrest warrant and we take you to jail."]
But aren't we talking about medical providers like doctors, nurses, and pharmacists? Isn't this just white collar crime?
[Agent Thompson: "It's white collar crime but, you know the back of our raid jackets say police."]
That's Agent Thompson, an assistant special agent in charge with the agency. She has more than two decades of experience in law enforcement and has investigated just about every type of health care fraud.
She's also an instructor at the agency's special agent training academy. One thing she stresses to the agents is how careful they have to be when they knock on a suspect's door, and say they're the police.
[Thompson: "I can't tell you how many search warrants I've done where we've come away with drugs and guns…yea, I think every single search warrant I've been on we've found at least one weapon."
Curtis: "You never know. A search warrant is one of the most dangerous things that we do. You don't know what's going to happen when you knock on someone's door. Whether you're there for the health care crime - those people don't know that. If Florence Bikundi or whoever else we're doing a search warrant on is committing other crimes that we have no idea about? Well, they don't know that we don't know that, they just know the police are knocking at the door and they might - that drives people to do things they normally wouldn't do."
[Music fade in]
Thompson: "You know, just because it's white collar crime, you know, we're going into their million-dollar mansions, and it's a potential that they could lose their livelihood, so no, they're not just going to be…you know…umm…"
Todd: "They're not just going to roll over."
Thompson: "Exactly. Or just go quietly. You know what I mean? There's a lot of risk involved."]
After careful planning, Agent Curtis and his team arrived at Bikundi's doorstep to arrest her in February 2014.
[Todd: "How did that go? What was her face like when she opened the door?"
Curtis: "So, she was completely shocked. She was completely shocked at the search warrant. It was one of those things where I don't think she ever believed it would get to this point, like we would figure this out."]
Fortunately, the arrest of Florence Bikundi was non-confrontational. Once they had her in custody, Agent Curtis could see firsthand where all that Medicaid money was going.
[Curtis: They had a huge house. It's a mansion. They had fake palm trees planted in the yard. A pool. A deckhouse out back. Numerous luxury vehicles."]
The vehicles alone were valued at over $400,000.
She took Medicaid fraud to a whole other level, to the point that Thanksgiving Day was every day at her house.
[Curtis: "Inside the house, they had a complete dining room table that was not being used, that was permanently set up to look like a Thanksgiving feast, with wax turkey, like a complete spread meal just decked out for looks. So, if you name it, they had it in their house. They spent the money that they got on, on opulence. They spent it, they wanted to look good. They had lavish parties at their house. They, they really put on a show."]
[Music fade out]
That's Thanksgiving Day. 365 days a year.
Investigators were able to prove in court that Global Healthcare cheated D.C.'s Medicaid program out of more than 80 million dollars.
That's $80 million that could've helped low income families, children, and individuals with disabilities.
[Thompson: "I don't think you'll find one agent who isn't passionate about, you know, their cases. And we don't want to let them go until someone has either paid restitution or what I like to tell folks is that we're selling jail time. You know - they're locked up. When you get that end result of a doctor getting sentenced to, you know, 40 months in prison, you know for, for Medicaid fraud and you know you're stripping them of that big mansion that Medicaid paid for - it's a good feeling. It's a good feeling. I think it's what keeps a lot of us going."]
After the arrest, the government was able to secure over eleven million dollars' worth of assets - seizing the cars, freezing more than 70 bank accounts, and putting a lien on the mansion.
The judge also ordered restitution to be paid back to Medicaid, but we'll discuss the aftermath of the trial and what happened to Florence Bikundi later on in the series.
[Music fade in]
Coming up in our next episode, we take a look at another extraordinary case that was part of the 2014 D.C. Takedown.
This time, the fraudsters went after an especially vulnerable population for their Medicaid scam: the homeless.
[Agent Lewis: "I've never seen this in any of my other cases. And I was actually, I actually couldn't believe what I was seeing. And it was so rampant all across the District."]
See you next time on This is Real.
I'm Todd Silver, thanks for listening.
This is Real is produced by the Department of Health and Human Services, Office of Inspector General. The agency reminds you that if you suspect fraud, waste, or abuse in any HHS programs including Medicaid or Medicare, report it to our Hotline at 800-447-8477, or 800-HHS-TIPS. Visit oig.hhs.gov for more information. Follow us on Twitter, like us on Facebook, and watch us on YouTube.