Agent Lewis is getting deeper into her investigation of widespread Medicaid fraud in Washington, D.C. However, she is running out of leads and still does not have enough evidence to make arrests. She enlists her colleague, Agent Rogers, to go undercover as a homeless person and infiltrate the scheme. How will Agent Rogers fit in? How deep can he get into the scheme? What if his real identity is revealed?
Previously on This is Real:
[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, it was so rampant all across the District."]
The home health care investigation worked by Agent Lewis was growing more and more complex.
Beneficiaries, patient recruiters, doctors, multiple home health care companies - it seemed as if everyone was involved in some aspect, and like a sturdy oak, the roots of the scheme kept spreading.
But connecting all the dots proved to be a major challenge.
Agent Lewis needed someone on the inside, to verify the fraud she was seeing on the outside and finally bust this scheme. But she couldn't get anyone to flip.
So she decided to bring in Agent Rogers to go...undercover.
[Rogers: "I got a call from my colleague who was working a home health agency case and it stemmed from allegations that there was some billing for beneficiaries in homeless shelters. I thought this was a great opportunity for me to go out there and I looked at it as a challenge. I, I was very excited. I was ready to get in, and dig in and just do something, totally different."]
The plan was to infiltrate the criminal network as a homeless person and collect evidence against the alleged fraudsters.
With any luck? He could find a way to obtain the information Agent Lewis needed for her case.
[Music intro and fade out]
Now, Agent Rogers was a seasoned veteran, with over 20 years' experience in law enforcement, but this was his first time going undercover as a homeless person, so I wanted to find out how he prepared for his covert operation.
[Todd: "When you went undercover, and you were preparing for it, did you watch TV shows or movies of undercover people and, if so, who did you try and emulate or who were you trying to look at to get some tips?"
Agent Rogers: "Well, you know it's interesting you asked that, but I just wanted to kind of be myself though. And I think, you know, there's no better person to be than yourself while you're out there."]
Agent Rogers said he was intrigued by the case, namely the involvement of the homeless in a home health scam.
[Rogers: "And that kind of stood out. I mean, homeless shelters with no home but they're billing for home health."]
He knew that going undercover as a homeless person presented many challenges.
He was about to go into a completely unfamiliar and unpredictable environment, so mental preparation was key.
[Rogers: "How can I even bring up a conversation with any of the individuals in the shelter? There was, you know, people were talking to themselves, and you know various actions, so that was the challenging part right there initially."]
Agent Rogers prepared himself for every situation that he could think of, rehearsing every element of his new identity.
He had to know his story, and his purpose for being at the homeless shelter.
He studied his name, his date of birth, the information on his Medicaid card.
How would he act once he got into the homeless shelter? Who would he approach? What would he say? And what if someone called him out?
[Rogers: "It was all about how can I fit in, and how could I break the ice once I got in the shelter."]
His first time out undercover, Agent Rogers prepared for a long day at the shelter, because he really didn't know what was going to happen.
I asked him what it was like inside. What were people doing? Was it crowded? What were the conditions?
Thing is, he said everything happened so fast, he doesn't even remember much about the shelter itself.
Only that it took a few minutes to find what he was looking for.
[Music fade in]
[Rogers: "I went into the shelter, I was able to, it didn't take me long, to talk to I believe a couple individuals and I pretty much you know said, 'Hey, I'm here I understand I can make some money. I have a Medicaid card and I was told I could make some money if I have I Medicaid card. Do you know anything about that?' And I would say about ten minutes later I was approached. I was approached by a recruiter."]
[Todd: "Give me, give me the real, like how did you really approach them? What'd you really say?"
Rogers: "Hehe. Hey what's going on, hey man what's happening man? You know I'm, I'm here, I got a Medicaid card. I'm looking to make some money. You know how I can make some money?"
Todd: "And just like that you had people coming at you?"
Rogers: "Hehe. Just like that. And I had a person to approach me once I said that. It was very interesting. It didn't take long at all for someone approached me just based on what I said there. And I was like 'Wow. Man I hit the jackpot.'"]
[Music fade in]
[Todd: "Now the person who approached you, was that a homeless person, too, or…?
Rogers: "No actually - he was a recruiter. He was a recruiter who worked at a home health agency. So he was actually in the building at the time that I came there. It just worked out that way."
Todd: "You're at a homeless shelter, and a guy is recruiting you for home health services?"
Rogers: "Can you imagine that? With no home and I'm at a homeless shelter. That's how bold, that's how bold they are."
Todd: "Why do you think they chose a homeless shelter? I guess that's where the Medicaid recipients are, you know?"
Rogers: "Ah, yes without a doubt. Most of the Medicaid, most of the people there at the homeless shelter are Medicaid recipients."]
The patient recruiter asked Agent Rogers a series of questions, mostly relating to his Medicaid status. He took Agent Rogers's Medicaid card and gave it to an accomplice, who verified that the card was valid, and active.
He then informed Agent Rogers that - yes indeed - he "could make some money with his Medicaid card."
The whole scenario was moving fast. The recruiters, it turned out, they were efficient businessmen.
These guys were on top of their game, and the operation was such a well-oiled machine that Agent Rogers was in and out of that homeless shelter in less than an hour.
Before he knew it, he was on his way to a doctor's office with the recruiter. What happened next? Well, that even surprised the veteran agent.
[Music fade out]
[Rogers: "It was unbelievable. When I walked into the waiting room, it appeared to be about 20 to 30 people just sitting around. There were other people coaching these individuals as to what to do, what to say once you go into the doctor's office."
Todd: "In the waiting room."
Rogers: "In the waiting room. So you can tell they were recruiters as well. So we're talking about a number of recruiters bringing patients in to this particular doctor's office, so they can get the necessary paperwork certified and signed to get home health."]
The patient recruiter coached Agent Rogers on what to say, and how to act once he went into the examination room.
He gave Agent Rogers a back brace and a cane as props for his fake illness.
He never even asked Agent Rogers if he actually had a real illness or injury. In fact, they never even talked about why Agent Rogers was homeless in the first place.
All that mattered, was that Agent Rogers had an active Medicaid card.
[Rogers: "He said, 'Hey, when you walk in, definitely walk in with some ailment. Let them know that you have issues with your knee or your back.' Something to tell the doctor to, I guess to qualify me to be able to get home health. As I walked into the doctor's office, you know I had to say 'Hey, my back, my knee,' whatever the case may be, and you know 'I need home health, I need a home health aide to come to my home.'
Todd: "The home that you don't have."
Rogers: "The home that I don't have. The recruiter realized that. I mean, because as the - he filled out the paperwork. And of course on the paperwork it asks for an address. So I was like, 'Hey, I'm homeless, man! You know? Ha, I don't have a home!' And he said, 'Well, aw man, do you have a girlfriend? Do you have someone's address? I just need to put an address down here.' You know, I had to be quick and think of an address! So I basically thought of an address right then and there to come up with as where my girlfriend lives."]
In the doctor's office, Agent Rogers complained of back pain and he played his part.
The doctor did a limited physical exam and then he wrote a prescription for Agent Rogers:
Home health care.
Eight hours a day.
Seven days a week.
All that from a doctor's visit that took less than five minutes.
[Music fade out]
[Todd: "He wrote a script for eight hours a day, seven days a week?
Todd: "And you walked in to, well even with a cane, you walked into his office - so you were mobile - and he gave you basically…I mean, what kind of person would need that much care? I figure they could hardly do anything themselves."
Rogers: "Right, right. And that's, that's, that's the part we couldn't understand. I mean why would this physician even sign off or order, or qualify me for home health, when he knew I pretty much walked in? Walked in, whether I had a cane or a back brace, but he gave me the maximum that I could get. You know because, I'm not sure but I believe that the recruiters were paying the physicians to give me the max."]
Once he got the forms signed and left the doctor's office, Agent Rogers met up with the patient recruiter outside.
[Rogers: "He said, 'Man, great job. Good job.' At that point I knew I got my foot in the door, I was on my way. And he paid me 60 dollars, just for the office visit."
And that was just the money the Medicaid recipient made. We may never know how much money other players made in this scheme.
What we do know is that this one doctor's visit for Agent Rogers's quote-unquote "back pain," spurned tens of thousands of dollars in Medicaid spending for unnecessary home health services.
As we learned in Episode 1, the annual cost to provide that amount of personal care prescribed to Agent Rogers, was almost 50,000 dollars.
On top of that, Agent Rogers was approached by at least eight different patient recruiters, and he met them everywhere - liquor stores, parking lots, grocery stores, motels, even outside churches.
He was promised up to $200 every few weeks for his role in the scheme. Of course, every cent he earned was placed into evidence.
I was curious how much money Agent Rogers made while he was undercover, so I decided to give him a call back to find out. You're not going to believe his answer.
[Music fade in]
[Rogers: "Well I was actually paid $59, but I was promised, they promised to pay me between $200 and $250 every two weeks - that's what they promised me.
Todd: "The recruiters were not only ripping off Medicaid, they're ripping you off too?
Rogers: "Yea, I was ripped off. I was totally ripped off. They kept the money that they were receiving on my behalf by using my Medicaid card."
[Music fade out]
Some of the patient recruiters also encouraged Agent Rogers to do some recruiting of his own, to earn more money for himself. And his recruiters.
But Agent Rogers wasn't in it for the money. His goal was to find a connection between the patient recruiters and the doctors.
The thing is - it's like walking a tight rope trying to collect evidence without exposing your cover.
[Rogers, "I think we kind of knew that these recruiters were actually paying the doctors, but how do you get up to the top? Um, very difficult for me, because they wouldn't give me that type of information.
"Um, I just wanted to first just on my level - on the recruiter's level - be able to go in and then get the doctors to sign off on the forms. And I was thinking more so, once we arrest the recruiters, bring them in, we were able to maybe flip the recruiters to give us that information to get up to the doctors. But I didn't want to pose too many questions to the recruiters, because I didn't just didn't want to give myself up."
Todd: "Because I'm sure that kind of puts you a little out of character."
Rogers: "Yes, that would definitely put me out of character, and I think that would have them thinking like, 'Hey, this guy might be law enforcement."
Todd: "You know, one of the things that Agent Lewis mentioned was that, there was almost a feeling from the beneficiary point of view that what they were doing wasn't really illegal. The patient recruiters made it sound almost like, like, well this is just part of the process. You go and get this stuff done, and then we, you know, we give you cash. Did the patient recruiters, like when they were trying to sell you on this, did they say anything like that, or tell you what the scenario would be like?
Rogers: "I recall that when I met one of the recruiters at the motel, he was trying to justify why they were doing this. It was almost like I was entitled to be paid and there was no, there was nothing wrong with it. He brought up the, he even said that, you know, you should be able to get a piece of the pie. So, that's the approach that they were using. They didn't really, after a while they didn't think they were doing anything wrong."]
Agent Rogers was undercover for almost a year.
He was constantly rehearsing his role, and reminding himself what he'd told the patient recruiters.
Agent Rogers was on-call, 24 hours a day, 7 days a week, because the patient recruiters would call at all times - day or night.
He never wanted to get tripped up, which might've put himself in a dangerous position. As prepared as he was, there were still some close calls…
[Music fade in]
[Rogers: "I recall going to a liquor store actually. Meeting a guy at the front of the liquor store. And he would get my information and my Medicaid card but he would take it over to another guy who would also run my Medicaid number. And this guy kept looking at me and looking at me and he was asking a lot of questions. At that same time, I heard one of the guys say, 'Wow, man, look at that car over there. It look like that could be a police car. And of course you know, heart kind of, you know, heh, turned around like 'Whoa, you know that ain't no police car, you know.' But I think at that point they might've spotted one of our, my cover team's vehicle. And, so that was, you know. That was interesting."]
[Music fade out]
He was able to talk his way out of the situation, but it put his senses on high alert.
[Rogers: "I'm quite sure if they found out that I was an undercover agent the circumstances wouldn't have been good. The situation wouldn't have been good because I could've, I kind of seen a mean streak in these guys. I mean, they were nice and all, but if they knew I was indeed the police or an agent, I don't think the situation would have turned out well."]
But it did turn out well.
Agent Lewis got what she needed from Agent Rogers, and she could finally take the case to the prosecutor and begin the next phase: indict, and arrest.
[Rogers: "It's just very unfortunate that we have these type of individuals taking advantage of the system. I just have a passion working these cases, and bringing money back and saving money for the government, and for, especially for our most vulnerable individuals and our seniors, it's just a great feeling. Very rewarding."]
Next time on This is Real, we wrap up the 2014 D.C. Takedown.
Who was arrested and who plead guilty? Who was convicted and who went to jail?
And what happened to Florence Bikundi and those involved in her million-dollar scheme?
Stay tuned for the final episode in this series.
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.