Texas doctor accused of huge health fraud scheme

A Texas doctor and six others were arrested Tuesday on charges they tried to  defraud federal health care programs of nearly $375 million in what U.S.  officials described as one of the largest schemes allegedly orchestrated by a  single doctor.

Dr. Jacques Roy, 54, of Rockwall, Texas, was charged with certifying or  directing the certification of more than 11,000 patients for home health care  services, which led to Medicare  being improperly billed for more than $350 million and Medicaid  being billed for more than $24 million.

“Dr. Roy’s company is alleged to have certified more Medicare  beneficiaries for home health services, and had more beneficiaries under its  care, than any other medical practice in the United States.”

– U.S. Deputy Attorney General James Cole

 

The alleged scheme ran between January 2006 and November 2011, though it was  not immediately clear how much was paid out by the two federal programs to Roy  and the others accused in the indictment unsealed on Tuesday.

“Dr. Roy’s company is alleged to have certified more Medicare beneficiaries  for home health services, and had more beneficiaries under its care, than any  other medical practice in the United  States,” U.S. Deputy Attorney General James Cole told reporters during a  news conference in Dallas.

A typical doctor certifies about 100 patients for home health services  whereas Roy personally certified thousands, according to Department of Health  and Human Services Inspector General Daniel Levinson.

He said that authorities are now better able to analyze data and root out  egregious cases of fraud. “Indeed until fairly recently it has been extremely  difficult to get that kind of real time data … Information technology has not  come online as quickly as we would like to see,” Levinson said.

Fraud in the health care industry has been a growing concern for the Obama  administration, and the Justice  Department has set up teams of prosecutors in key cities to focus solely on  those cases as attempts to defraud the programs increase.

The so-called strike forces were created in March 2007, and since then at  least 1,190 people have been charged over alleged false billing to Medicare for  more than $3.6 billion.

“This (case) represents the single largest fraud amount orchestrated by one  doctor in the history of our Medicare Fraud Strike Force operations,” Cole  said.

The Justice Department also sought to seize numerous bank accounts, homes and  other property including several vehicles and two sailboats owned by Roy – one  of which is named “One Trick Pony,” according to court records.

Home health services are usually provided when somebody is confined to their  home and a doctor determines they need such care.

Roy was also accused of using several home health agencies to recruit  patients so that his firm, Medistat, could bill for unneeded home visits and  medical services and bill for some services that were never provided.

Despite the requirement that the patient be homebound, “some of these people  were out working on their cars when they were approached. He was selling his  signature,” U.S. Attorney for the Northern District of Texas Sarah Saldana told  reporters.

CMS suspended Roy’s ability to bill Medicare in June 2011, but the indictment  said he simply used another company that he controlled to certify patients for  home health services.

HHS’ Center for Medicare and Medicaid Services also suspended 78 home health  agencies with ties to Roy pending further investigation to determine if they  were engaged in allegedly fraudulent activities.

One of those also accused recruited homeless people staying at a Dallas  shelter to be used in the scheme, according to the indictment filed last week  and unsealed on Tuesday.

Also charged in the indictment were Roy’s office manager, Teri Sivils, and  the owners of five home health agencies: Cynthia Stiger, Wilbert Veasey, Jr.,  Cyprian Akamnonu, Patricia Akamnonu, and Charity Eleda.

They were indicted for conspiracy to commit health care fraud while Roy was  also charged with nine counts of health care fraud. Veasey, Patricia Akamnonu  and Eleda were also charged with three counts of health care fraud and Eleda was  charged with three counts of making false statements.

The conspiracy and fraud charges each carry a maximum sentence of up to 10  years in prison and a $250,000 fine, while the false statements counts each  carry a maximum sentence of five years in prison and a similar fine.

The case is USA v. Roy et al, in U.S. District Court for the District of  Northern Texas, No. 12-cr-54.

Read more: http://www.foxnews.com/health/2012/02/29/texas-doctor-accused-huge-health-fraud-scheme/#ixzz1nydXERuE