A Texas doctor masterminded the largest health care fraud in American history, federal authorities said on Tuesday as they accused him and six other people of bilking the Medicare program of some $375 million in a scheme that went on for years.
Dr. Jacques Roy, 54, of Rockwall, near Dallas, and his co-conspirators allegedly raked in millions by billing Medicare for home-health services that were never provided. Prosecutors called it “a staggering and lone-running fraud scheme” that included recruiting “patients” from homeless shelters and falsely peddling forms with the doctor’s signature already affixed. Read the indictment here.
The criminality by Dr. Roy and the others, including two registered nurses and office assistants, lasted at least half a decade, prosecutors in the Northern District of Texas said.
“Thanks to the historic partnerships we’ve built to combat health care fraud, we are sending a clear message: If you victimize American taxpayers, we will track you down and prosecute you,” Deputy Attorney General James Cole said in a statement.
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From left: HHS Deputy Secretary Bill Corr, U.S. Attorney for the Northern District of Texas Sarah R. Saldaña, Deputy Attorney General James Cole and Assistant Attorney General for the Criminal Division Lanny Breuer. (Credit: DOJ)
The largely sham health organization run by Dr. Roy, Medistat Group Associates (which did business as Healthcare Medical Associates) certified more Medicare beneficiaries for home health services and had more patients than any other medical practices in the United States, according to the indictment unsealed in Dallas on Tuesday. Dr. Roy allegedly certified more than 11,000 patients from more than 500 health home agencies for home services in the past five years, according to the indictment. The certifications, the government alleges, resulted in more than $350 million in fraudulent bills to Medicare and more $24 million to Medicaid.
In addition, 78 health home agencies associated with Dr. Roy have been suspended pending litigation.
The doctor could spend the rest of his life in prison if he is convicted, prosecutors said as they moved to keep him in custody until trial. As evidence of his criminal mind-set and his likelihood of being a flight risk, the authorities said the doctor has set up off-shore bank accounts and has possessed various phony identification documents.
Teri Sivils, the doctor’s office manager in DeSoto, Tex., was also indicted, as was registered nurse Charity Eleda and four others associated with the enterprise. Cynthia Stiger and Wilbert James Veasey Jr., owners of a home health agency associated with Roy, were also charged with conspiracy to commit health care fraud, according to a news release. Patricia Akamnonu and Cyprian Akamnonu, also associated with Roy, were indicted.
All face charges of conspiracy to commit health care fraud. Roy is also charged with nine counts of substantive health care fraud. Veasey and Patricia Akamnonu are each charged with health care fraud, according to the indictment. Eleda is charged with health care fraud and making false statements related to a Medicare claim, according to the documents.
The takedown was part of the three-year-old Health Care Fraud Prevention & Enforcement Action Team, also referred to as HEAT. HEAT’s Medicare Fraud Strike Force operations spearheaded the investigations, according to a department news release.
In a statement, Assistant Attorney General for the Criminal Division Lanny Breuer said the strikeforce has charged more than 800 defendants with alleged fraud of more than $2.2 billion.
“The conduct charged in this indictment represents the single largest fraud amount orchestrated by one doctor in the history of HEAT and our Medicare Fraud Strike Force operations,” Cole said in the statement.
The announcement of the charges coincided with Attorney General Eric Holder’s statements to the House Appropriations Committee that the Department of Justice is making health care fraud a top priority.
Assistant U.S. Attorneys Michael C. Elliot, Mindy Sauter and John DelaGarza of the Northern District of Texas are prosecuting the case, in addition to trial attorney Ben O’Neil and Deputy Chief of the Criminal Division’s Fraud Section Sam S. Sheldon.
Come on justice, you guy’s are the reason $80 Billion in Medicare fraud walks out the door every year…… and why states are bankrupt over healthcare costs…….. you guy’s refuse to report where all the fraud profits really go. How about you guy’s write about how DOJ protects the wholesale Medicare rackets….. http://bit.ly/woimAs
Can’t do that cause these guy’s are your friends……how proud you must be to help protect $77.8 Billion in Medicare fraud……