Five Washington, D.C., home health care companies received a combined $820.5 million in taxpayer-funded Medicaid payments after District regulators began proceedings to terminate them over fraud allegations, according to a WBFF investigation. None of the five has been convicted of fraud, and D.C. officials continued paying the companies during years of scrutiny.
The figures come from a WBFF investigation, part of the Spotlight on Maryland project, which found the five companies received the payments since 2015 despite the termination proceedings. T & N Reliable Nursing Care topped the list at $221.2 million, followed by Immaculate Health Care Services at $182.3 million, ABA Home Health Care at $155.8 million, Health Management Inc. at $153 million, and Premier Health Services at $108.3 million. Across the broader system, D.C. home health care Medicaid funding totaled at least $1.47 billion from 2018 through 2024, or roughly $211 million a year, according to the same investigation.
A 2014 Crackdown That Didn't Stick
The episode began with a 2014 federal, Maryland and D.C. crackdown that authorities called the largest health care fraud takedown in D.C. history. More than 20 people were arrested in schemes involving falsified billing records and patient kickbacks. The head of several D.C. and Maryland health care companies was convicted in a Medicaid fraud scheme involving more than $80 million and sentenced to 10 years in prison. District records show that, effective July 15, 2014, the D.C. Department of Health Care Finance moved to terminate six home-care agencies—ABA Home Health Care, Nursing Enterprises, Nursing Unlimited, T&N Reliable Nursing Care, Global and Vizion One—after issuing notices to 13 providers under investigation, according to DHCF.
The five companies examined in the WBFF investigation are not identical to the six agencies named in DHCF's 2014 termination notice. The investigation reported that D.C. regulators later lifted some payment suspensions after settlements and performance requirements. DHCF told the outlet that it imposed performance expectations and required some providers to reimburse the agency for questioned claims, but it did not provide specific details about the terminations or settlements. In Health Management Inc.'s case, DHCF said there was not a supportable case of fraud at that time. The D.C. Office of Administrative Hearings upheld fraud allegations that led to the termination of several other suspended companies.
Inspections Found Gaps in Patient Care
Inspection Records Show Gaps in Patient Care
Financial trouble has also dogged some of the companies. Immaculate Health Care Services had a $3.27 million tax lien issued in 2015 and paid roughly $139,000 in tax liens between 2019 and 2020. T&N had a $238,000 Maryland tax lien issued in 2014, though it paid off two earlier Maryland tax liens totaling about $1.2 million back in 2011. T&N is led by Agnes Nkeng and lists a Bowie, Maryland address at a house owned by Nkeng that was valued at $1.9 million, the investigation found. Premier Health Services is led by Ijeoma Arungwa and received strict operating standards addressing administrative failures, according to the report. All five companies declined to make leadership available for interviews.
Lawsuits Add to the Companies' Track Record
Beyond the fraud allegations, the companies' track records have also drawn scrutiny. The investigation discussed Health Management Inc. and T&N, while in a case that predates the current group of companies, Premier Health Services agreed to pay Flo Diamond Health Care $100,000 in a 2009 settlement. The report also mentioned a separate $80 million global health care Medicaid-fraud case.
Why Oversight Remains So Difficult
Home care Medicaid programs allow companies and patients to bill for services delivered inside private residences, a structure that makes oversight inherently harder than in a clinic or hospital. OJ Oleka said home health care programs are ripe for fraud because oversight is difficult in patients' homes, according to the investigation, which also emphasized the difficulty of overseeing D.C.'s home care Medicaid program. Compounding the problem, the D.C. Medicaid Fraud Control Unit had limited law enforcement authority in Maryland and Virginia as of 2023, even though maryland-based home-care providers received hundreds of millions of dollars through D.C. Medicaid.
The program's growth has outpaced its guardrails for years. D.C. personal-care program spending grew from $71 million in 2008 to $110 million in 2010, while the number of beneficiaries rose about 68 percent over the same period; payment suspensions during the 2014 crackdown potentially affected 79 percent of program beneficiaries. D.C. Medicaid funding draws on federal and local taxpayer dollars, leaving both federal and District taxpayers exposed when oversight falls short. DHCF has said it revamped oversight after the crackdown, suspending more than three dozen providers since then and saving more than $100 million annually in Medicaid home-care spending. Wayne Turnage discussed the need for an orderly transition, according to the investigation.
What D.C. says it changed
The District's payment-integrity efforts have unfolded alongside rapid growth in participant-directed care. According to the D.C. Department of Health Care Finance, its Medicaid Services My Way program began in March 2016 and had more than 1,100 participants by February 2021—over five times the original enrollment forecast. DHCF also identified Electronic Visit Verification, or EVV, as one of the technologies being implemented in broader Medicaid program changes. The available agency statements document the technology and enforcement steps, but they do not establish that every home- and community-based service was subject to the same controls. DHCF has reported suspending more than three dozen providers since the 2014 crackdown and saving more than $100 million annually in Medicaid home-care spending, while national rules separately require states to use EVV to record core details of in-home services.
A National Pattern of Fraud Fights
The D.C. findings land amid a broader national push against Medicaid fraud. Fraud convictions involving personal-care service attendants averaged well over 400 a year and made up 43% of all Medicaid Fraud Control Unit convictions from 2015 through 2022, according to KFF. That figure dropped somewhat in fiscal year 2024, when there were 298 such convictions, representing 36% of all convictions that year. In 2016, Congress passed the 21st Century Cures Act, requiring states to implement electronic visit verification systems that record the beneficiary, caregiver, service type, location, date, and start and end times for home-based services.
Enforcement has since escalated at the federal level. The KFF report discusses Medicaid Fraud Control Unit convictions nationwide. The available reporting does not detail additional 2026 federal actions involving an executive task force, provider-enrollment pauses or state Medicaid funding deferrals.
