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02-28-2012, 07:23 PM
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A Texas doctor and five owners of home health agencies were arrested today on charges that they are part of a nearly $375 million fraudulent home health-care ring that authorities say is the largest such case ever against a single doctor.
The doctor, Jacques Roy, 54, of Rockwall, Tex., was charged in an indictment with masterminding a Medicare fraud conspiracy over the past five years. The alleged fraud involved classifying as homebound 11,000 patients from more than 500 agencies, and then billing unnecessary services and home visits, according to the indictment filed in the Northern District of Texas.
Roy’s alleged scheme resulted in more than $350 million being fraudulently billed to Medicare and more than $24 million being fraudulently billed to Medicaid.
“The conduct charged in this indictment represents the single largest fraud amount orchestrated by one doctor,” said Deputy U.S. Attorney General James Cole. “If you victimize American taxpayers, we will track you down and prosecute you.”
Tuesday’s indictment is the latest in a series of Medicare fraud cases, which have become a centerpiece of the Obama administration’s push to cut health-care costs. A recent report indicated that health-care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars last year, the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers by seeking payments to which they weren’t entitled.
Investigators from the Department of Health and Human Services targeted Roy’s business after analyzing Medicare billing data and finding a disproportionately large number of home health claims for which Roy was the certifying physician.
Between January 2006 and November 2011, Roy’s business, Medistat Group Associates, certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States, officials said.
“Using sophisticated data analysis, we can now target suspicious billing spikes,” said HHS Inspector General Daniel R. Levinson. “In this case, our analysts discovered that in 2010, while 99 percent of physicians who certified patients for home health signed off on 104 or fewer people, Dr. Roy certified more than 5,000.”
According to the indictment, Roy owned and operated Medistat in the Dallas-Fort Worth area. It was an association of health-care providers that primarily provided home health certifications and visited patient’s homes. Roy allegedly used the home health agencies as recruiters so that Medistat could bill unnecessary home visits and medical services.
As part of his business, Roy allegedly maintained a “485 Department,” named after the number on the Medicare form on which the plan of care was documented. He allegedly instructed his employees to complete the 485s by either signing his name by hand or by using his electronic signature on the document.
Along with the indictment, the Centers for Medicare and Medicaid also announced the suspension of payments to an additional 78 home health agencies associated with Roy, based on credible allegations of fraud against them, authorities said. Roy’s office manager is also charged in the indictment.
Owners of the home health agencies working with Roy would recruit people so that they could bill Medicare for the unnecessary and not-provided services, according to the indictment. One of the owners, Charity Eleda, 51, of Rowlett, Tex., allegedly visited a homeless shelter in Dallas to recruit homeless beneficiaries staying at the shelter, paying recruiters $50 per beneficiary they found at the Bridge Homeless Shelter.
“This case and our new detection tools are examples of our growing ability to stop Medicare fraud,” said HHS Deputy Secretary Bill Corr.
Roy and the other defendants are expected to make their initial appearances Tuesday in federal court in Dallas. In addition to Eleda, the others charged in the case are Cynthia Stiger, 49, and Wilbert J. Veasey Jr., 60, both of Dallas; Cyprian Akamnonu, 63, and Patricia Akamnonu, 48, both of Cedar Hill, Tex.; and Teri Sivils, 44, of Midlothian, Tex.
Roy is charged with one count of conspiracy to commit health-care fraud and nine counts of substantive health-care fraud. If convicted, he faces possible life in prison.
A Texas doctor and five owners of home health agencies were arrested today on charges that they are part of a nearly $375 million fraudulent home health-care ring that authorities say is the largest such case ever against a single doctor.
The doctor, Jacques Roy, 54, of Rockwall, Tex., was charged in an indictment with masterminding a Medicare fraud conspiracy over the past five years. The alleged fraud involved classifying as homebound 11,000 patients from more than 500 agencies, and then billing unnecessary services and home visits, according to the indictment filed in the Northern District of Texas.
Roy’s alleged scheme resulted in more than $350 million being fraudulently billed to Medicare and more than $24 million being fraudulently billed to Medicaid.
“The conduct charged in this indictment represents the single largest fraud amount orchestrated by one doctor,” said Deputy U.S. Attorney General James Cole. “If you victimize American taxpayers, we will track you down and prosecute you.”
Tuesday’s indictment is the latest in a series of Medicare fraud cases, which have become a centerpiece of the Obama administration’s push to cut health-care costs. A recent report indicated that health-care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars last year, the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers by seeking payments to which they weren’t entitled.
Investigators from the Department of Health and Human Services targeted Roy’s business after analyzing Medicare billing data and finding a disproportionately large number of home health claims for which Roy was the certifying physician.
Between January 2006 and November 2011, Roy’s business, Medistat Group Associates, certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States, officials said.
“Using sophisticated data analysis, we can now target suspicious billing spikes,” said HHS Inspector General Daniel R. Levinson. “In this case, our analysts discovered that in 2010, while 99 percent of physicians who certified patients for home health signed off on 104 or fewer people, Dr. Roy certified more than 5,000.”
According to the indictment, Roy owned and operated Medistat in the Dallas-Fort Worth area. It was an association of health-care providers that primarily provided home health certifications and visited patient’s homes. Roy allegedly used the home health agencies as recruiters so that Medistat could bill unnecessary home visits and medical services.
As part of his business, Roy allegedly maintained a “485 Department,” named after the number on the Medicare form on which the plan of care was documented. He allegedly instructed his employees to complete the 485s by either signing his name by hand or by using his electronic signature on the document.
Along with the indictment, the Centers for Medicare and Medicaid also announced the suspension of payments to an additional 78 home health agencies associated with Roy, based on credible allegations of fraud against them, authorities said. Roy’s office manager is also charged in the indictment.
Owners of the home health agencies working with Roy would recruit people so that they could bill Medicare for the unnecessary and not-provided services, according to the indictment. One of the owners, Charity Eleda, 51, of Rowlett, Tex., allegedly visited a homeless shelter in Dallas to recruit homeless beneficiaries staying at the shelter, paying recruiters $50 per beneficiary they found at the Bridge Homeless Shelter.
“This case and our new detection tools are examples of our growing ability to stop Medicare fraud,” said HHS Deputy Secretary Bill Corr.
Roy and the other defendants are expected to make their initial appearances Tuesday in federal court in Dallas. In addition to Eleda, the others charged in the case are Cynthia Stiger, 49, and Wilbert J. Veasey Jr., 60, both of Dallas; Cyprian Akamnonu, 63, and Patricia Akamnonu, 48, both of Cedar Hill, Tex.; and Teri Sivils, 44, of Midlothian, Tex.
Roy is charged with one count of conspiracy to commit health-care fraud and nine counts of substantive health-care fraud. If convicted, he faces possible life in prison.