Largest Medicare Fraud

February 29, 2012 by staff 

Largest Medicare Fraud, Federal officials say they have taken down the largest Medicare fraud scheme investigators have ever discovered: a $375 million dollar home healthcare scam operating in the Dallas, Texas area.

The alleged “mastermind” of the fraud, Dr. Jacques Roy, is charged with certifying hundreds of fraudulent claims for Medicare reimbursement and pocketing millions in payments for services not needed, or never delivered. Prosecutors say the 54-year-old Dr. Roy, who was arrested on Tuesday and could be sentenced to life in prison, operated a “boiler room” to churn out thousands of phony Medicare claims and recruited homeless people as fake patients.

“Today, the Medicare Fraud Strike Force is taking aim at the largest alleged home health fraud scheme ever committed,” said Assistant Attorney General Lanny Breuer. “According to the indictment, Dr. Roy and his co-conspirators, for years, ran a well-oiled fraudulent enterprise in the Dallas area, making millions by recruiting thousands of patients for unnecessary services, and billing Medicare for those services.”

The government charges that Dr. Roy was planning to take the money and run. He allegedly hid much of his Medicare money in an offshore account in the Cayman Islands. In documents filed in court Tuesday, the government charges that Dr. Roy was planning to change his identity and flee the country to avoid prosecution. In a motion opposing bail for Dr. Roy, prosecutors claim that he had created a false Canadian identity under the name Michel Poulin, had a copy of a book called Hide Your A$$ET$ and Disappear, and a guide to yacht registration in the Caymans.

Dr. Roy’s scam was clever, wide-ranging, and very profitable, according to prosecutors. He allegedly exploited the Medicare regulation that requires a doctor to “certify” that Medicare services are legitimate — that they are needed and are being delivered to the patient. Dr. Roy allegedly sold his certification as “a commodity” to nearly 500 home health care companies in Texas, certifying patients for Medicare services regardless of whether they needed them or received them. In return, the government charges, Dr. Roy would receive a portion of the fraudulent Medicare payment.

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