Holy Health Wasn’t Really Holy
Husband and wife team Julius and Eugenie Bakari are the owners of Holy Health Care Services, or Holy Health, and together with an employee, Dominic Forka, they are charged with health care kickbacks, conspiracy to receive unlawful kickbacks, and health care fraud. Forka is a Community Support Worker (CSW). Together, the threesome found a way to bilk the government out of thousands.
Dancing with the Devil
As president and vice president of Holy Health, the Bakari’s found a way to bill the government by using Forka and his social worker credentials for services never provided. They entered into agreements with the District of Columbia’s Department of Health Care, and registered with various mental health agencies of the state to give legitimacy as a provider of services.
I have to admit it was “clever” in a highly unethical way. They allegedly paid homeless people to come to their offices for “treatment.” It was essentially a round-up. The facility sent out a van to a park, picked up “patients” and transported them to the facility.
The patients “signed in” for their treatments even though Holy Health did not provide such treatment. Allegedly, the patients saw a “doctor” from time to time to lend some type of official stamp to the visit, but usually they did not meet with a doctor, signed in and were given cash. The “patients” got $25 for attending three appointments a week.
According to the Department of Justice:
“Holy Health did not provide mental health services to the homeless individuals and continued to bill Medicaid for mental health services even after the individuals stopped attending appointments.”
Someone either reported Holy Health, or perhaps an undercover officer began to notice the unusual van activity in the park said to be located near the government printing office. In any event the sources went undercover in the time period from March to November 2019.
One of those undercover workers received payment for 25 full-hour treatments of 60-minute never attended and the other undercover person for 32 appointments never attended. On other occasions, they did attend sessions that were presumably to be one hour, but they lasted just minutes.
The defendants could receive up to 10 years in federal prison for healthcare kickbacks and fraud.
Medicaid Flaws
As I sit here and write this, I am struck with the continuing, massive amount of fraud within the Medicaid system. According to the 2020 fraud report, “Similar to previous years, significantly more convictions for fraud involved personal care services (PCS) attendants and agencies than any other provider type.”
In 2020 Medicaid prosecution resulted in 1,017 convictions and more than $1 billion recovered. At least 21 facilities of the Holy Health type were charged with fraud. In 2020, it was estimated that there was about $87 billion in fraudulent payments. Incredibly it was about 21 percent of the total payments made.
There are no statistics available on how many routinely get away with overcharging and almost getting caught. It is impossible to calculate the full extent of how much money the healthcare system loses every year to theft of services. If we are looking for a single, major culprit, we won’t find it. The Holy Health scam amounted to only about $500,000 in the pockets of those charged.
The government is being bled dry. The amount is staggering because the system is so flawed. As there is little oversite in many cases, there is an ongoing opportunity for theft. If the current system is as flawed as it would seem, perhaps ethics – not the government – is to blame.
There are virtually no limits, to the number of studies that have been conducted on patient-physician or patient-healthcare trust. Generally speaking, the numbers are positive.
However, we have seen little data on patient perception of the ethics as to how their providers bill the system. In truth, most patients have no idea how insurance is billed by the provider. Perhaps the unethical providers understand this.
It would seem we are all overdue for a different kind of transparency. An ethical transparency where patients gain a greater understanding of how medical practices are billing insurers. Perhaps that would go a long way to reducing fraud.
LEAVE YOUR COMMENTS!
The fact is, catching Medicaid fraud is virtually impossible. Only after audit can the inconsistencies be revealed and at best that happens yearly. I think this is a moment for HHS to consider how AI can be leveraged within CMS billing systems. No one human or even department of human beings has the time/resources/algorithm to comb through that volume of claims. But AI can!