Ever wonder how the OIG investigates fraud? What do they look for? What challenges to they face? Well, the OIG has recently released a 5-episode podcast series,“This is Real,” which follows HHS OIG special agents as they work to uncover the complex fraud schemes, expose the greed of those involved, and bring the criminals to justice. And all of this is real! This is Real, is produced by the Department of Health and Humans Services, Office of Inspector General.
The series digs deep into a case from 2014, where more than 30 people were arrested in the nation's capital on charges related to health care fraud. Those arrested included owners and operators of home health care agencies, office workers, personal care assistants, and patient recruiters. Millions of dollars in bank accounts and property were seized, and the bust remains the biggest health care fraud takedown in Washington, D.C., history.
The agency first learned about the case from the D.C. Department of Health. They run the Medicaid program in the nation's capital. The tip included three allegations:
First, that Florence Bikundi's company, Global Healthcare, was submitting false documents to Medicaid. Second, they were billing for services that never occurred. And third, that Global Healthcare was hiring patient-recruiters. Now, these recruiters were targeting Medicaid beneficiaries to sign up for home health care, even if there was no medical reason for it.
Episodes run from 11-17 minutes and each includes a transcript. In the series opener of This is Real, OIG takes the listener through one of the biggest health care fraud cases in Washington, D.C., history. Follow Agent Curtis as he goes down one rabbit hole after another to unravel a million-dollar Medicaid fraud scheme orchestrated by a woman who was banned from billing the Medicaid program.
In the second episode, Agent Curtis has a major breakthrough in his investigation of Florence Bikundi and her scheme to steal millions from Medicaid. He prepares to arrest her at her lavish mansion, but given all the money at stake, would she go quietly?
The third episode highlights how investigating Medicaid fraud can be difficult, especially when there are so many different players involved. Agent Lewis has a puzzle on her hands, and the pieces aren't fitting where they should. Agent Lewis tracks a home health care fraud scheme that has grown rampant across the Washington, D.C. area.
In the fourth episode, 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?
In the final episode OIG wraps up the D.C. Takedown. Who was arrested and who pled guilty? How much money was recovered and who went to jail? Find out how these agents are fighting these fraud schemes today.
In my years of working in compliance, I haven’t seen a series like this from the OIG. Personally, I think it is a great way to raise awareness of healthcare fraud, waste and abuse. It also serves as a good reminder that an effective compliance program is the best way to prevent these sorts of things from happening within your organization.
Listen to the series here.
CJ Wolf
Questions or Comments?