Texas physician Dr. Jacques Roy, 54, set a U.S. Justice Dept. record when he was arrested for allegedly bilking $375 million in fraudulent payments from government health programs over 5 years.
Roy was indicted alongside 5 owners of home health agencies in the Dallas area, who were arrested on charges of conspiracy to commit health care fraud. Roy owned and operated Medistat Group Associates, a home health care certification practice that had more purported patients than any other medical practice in the U.S., according to the DOJ.
"The conduct charged in this indictment represents the single largest fraud amount orchestrated by 1 doctor in the history of HEAT and our Medicare Fraud Strike Force operations," Deputy Attorney General Cole said in prepared remarks. "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."
Alongside the indictment, the Centers for Medicare & Medicaid Services suspended payments totalling $2.3 million a month to 78 home health agencies associated with Roy, the Wall Street Journal reported.
Roy allegedly used the home health agencies as "recruiters" so that Medistat could bill home visits and medical services that weren’t necessary or weren’t provided. One HHA allegedly paid a Dallas shelter $50 per beneficiary to help sign on homeless people as “patients” for the home health services.
Medistat signed up more than 11,000 patients for Medicare certification in the past 5 years, according to the DOJ, more than any other medical practice in the nation, costing more than $350 million in Medicare payouts and more than $24 million more from Medicaid.
The fraud scheme was more complex than traditional busts, U.S. attorneys said, and they may have continued to evade notice without new enforcement programs.
"Using sophisticated data analysis we can now target suspicious billing spikes," HHS Inspector General Levinson said in prepared remarks. "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."
