Texas doctor accused of huge health fraud scheme

A Texas doctor and six others were arrested Tuesday on charges they tried to defraud federal health care programs of nearly $375 million in what U.S. officials described as one of the largest schemes allegedly orchestrated by a single doctor.

Dr. Jacques Roy, 54, of Rockwall, Texas, was charged with certifying or directing the certification of more than 11,000 patients for home health care services, which led to Medicare being improperly billed for more than $350 million and Medicaid being billed for more than $24 million.

[pullquote]

The alleged scheme ran between January 2006 and November 2011, though it was not immediately clear how much was paid out by the two federal programs to Roy and the others accused in the indictment unsealed on Tuesday.

"Dr. Roy's company is alleged to have certified more Medicare beneficiaries for home health services, and had more beneficiaries under its care, than any other medical practice in the United States," U.S. Deputy Attorney General James Cole told reporters during a news conference in Dallas.

A typical doctor certifies about 100 patients for home health services whereas Roy personally certified thousands, according to Department of Health and Human Services Inspector General Daniel Levinson.

He said that authorities are now better able to analyze data and root out egregious cases of fraud. "Indeed until fairly recently it has been extremely difficult to get that kind of real time data ... Information technology has not come online as quickly as we would like to see," Levinson said.

Fraud in the health care industry has been a growing concern for the Obama administration, and the Justice Department has set up teams of prosecutors in key cities to focus solely on those cases as attempts to defraud the programs increase.

The so-called strike forces were created in March 2007, and since then at least 1,190 people have been charged over alleged false billing to Medicare for more than $3.6 billion.

"This (case) represents the single largest fraud amount orchestrated by one doctor in the history of our Medicare Fraud Strike Force operations," Cole said.

The Justice Department also sought to seize numerous bank accounts, homes and other property including several vehicles and two sailboats owned by Roy - one of which is named "One Trick Pony," according to court records.

Home health services are usually provided when somebody is confined to their home and a doctor determines they need such care.

Roy was also accused of using several home health agencies to recruit patients so that his firm, Medistat, could bill for unneeded home visits and medical services and bill for some services that were never provided.

Despite the requirement that the patient be homebound, "some of these people were out working on their cars when they were approached. He was selling his signature," U.S. Attorney for the Northern District of Texas Sarah Saldana told reporters.

CMS suspended Roy's ability to bill Medicare in June 2011, but the indictment said he simply used another company that he controlled to certify patients for home health services.

HHS' Center for Medicare and Medicaid Services also suspended 78 home health agencies with ties to Roy pending further investigation to determine if they were engaged in allegedly fraudulent activities.

One of those also accused recruited homeless people staying at a Dallas shelter to be used in the scheme, according to the indictment filed last week and unsealed on Tuesday.

Also charged in the indictment were Roy's office manager, Teri Sivils, and the owners of five home health agencies: Cynthia Stiger, Wilbert Veasey, Jr., Cyprian Akamnonu, Patricia Akamnonu, and Charity Eleda.

They were indicted for conspiracy to commit health care fraud while Roy was also charged with nine counts of health care fraud. Veasey, Patricia Akamnonu and Eleda were also charged with three counts of health care fraud and Eleda was charged with three counts of making false statements.

The conspiracy and fraud charges each carry a maximum sentence of up to 10 years in prison and a $250,000 fine, while the false statements counts each carry a maximum sentence of five years in prison and a similar fine.

The case is USA v. Roy et al, in U.S. District Court for the District of Northern Texas, No. 12-cr-54.