Medicare Fraud Arrests

February 29, 2012 by staff 

Medicare Fraud Arrests, Federal authorities on Tuesday made arrests in the most expansive case of alleged Medicare fraud to date. The case involves a Dallas doctor and dozens of home-health providers accused of bilking taxpayers for more than $375 million in bogus claims.

The indictment, filed in the Northern District of Texas and unsealed Tuesday, charges Dr. Jacques Roy of Rockwall, Texas, with conspiracy to commit health care fraud and nine counts of substantive health care fraud. Six others are charged along with Roy with conspiracy to commit health care fraud, with some of those defendants also facing additional charges stemming from the alleged scheme. Additionally, the Centers for Medicare and Medicaid Services – the government agency responsible for overseeing the massive government insurance programs – has suspended 78 home health agencies associated with Roy based on credible allegations of fraud against them.

Home health is a common source of Medicare and Medicaid fraud, but the Dallas case is noteworthy nationally because of its breadth. As an example, a recent Louisiana-based Medicare fraud case involved multiple players charged with masterminding a $4.7 million scheme.

“The conduct charged in this indictment represents the single largest fraud amount orchestrated by one doctor in the history of HEAT (Health Care Fraud Prevention & Enforcement Action Team) and our Medicare Fraud Strike Force operations,” said U.S. Deputy Attorney General James Cole in a written statement. “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.”

The government accuses of Roy, who owned and operated a firm called Medistat, of systematically certifying patients for home health care services that were not needed. Medistat was an association of health care providers that primarily provided home health certifications and performed patient home visits. The other defendants were either Medistat employees or representatives of firms that recruited beneficiaries to be the subject of bogus claims submitted using the approvals that Roy provided.

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