Global Healthcare, Inc.
Outcome
Owners Florence Bikundi and Michael D. Bikundi Sr. of Global Healthcare Inc. were sentenced to prison after defrauding the DC Medicaid program of over $80 million through their home care agency.
Details
Global Healthcare, Inc. (Washington DC) — $80 Million DC Medicaid Fraud (2016)
Outcome: Florence Bikundi and Michael D. Bikundi Sr., owners of Global Healthcare Inc., were sentenced to prison on June 1, 2016 after defrauding the DC Medicaid program of over $80 million through their Washington DC home care agency.
Florence and Michael Bikundi operated Global Healthcare, Inc., a home care agency enrolled in the District of Columbia Medicaid program. They and their co-conspirators systematically defrauded DC Medicaid of over $80 million through fraudulent billing for home care services. The scheme also involved money laundering of the fraudulently obtained proceeds.
At over $80 million, this ranks among the largest individual home health Medicaid fraud cases in U.S. history. The DC Medicaid program, which serves a concentrated urban population with high rates of home care need, was particularly vulnerable to this systematic fraud. The case was prosecuted by the U.S. Attorney's Office for the District of Columbia.
Primary Source: OIG Enforcement Record
How Crucible Prevents This
Crucible's Medicaid billing audit hooks and anti-money-laundering compliance controls would detect the systematic false claims pattern at this scale. Automated cross-referencing of service delivery documentation against billed claims, combined with anomaly detection on billing volume relative to enrolled beneficiaries, would surface large-scale fraud schemes.
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