A Texas doctor, his office manager and five owners of home health agencies were arrested Tuesday in what law enforcement officials are calling "the largest alleged home health fraud scheme ever committed."
Jacques Roy, MD, 54, of Rockwell, Texas and the six others, have been accused of allegedly participating in a scam making $375 million in fraudulent claims for home health services. Among its accusations, the government claims that the accused recruited patients falsely, going even so far as to pay homeless people $50 per person to sign fake forms.
According to the Department of Justice, between January 2006 and November 2011, Roy's business, Medistat Group Associates, certified more Medicare beneficiaries for home health services and had more supposed patients than any other medical practice in the United States. These certifications resulted in more than $350 million being charged to Medicare and more than $24 million charged to Medicaid.
The government's enforcement actions resulted from investigations by the Medicare Fraud Strike Force, which is part of the Health Care Fraud Prevention and Enforcement Action Team (HEAT). HEAT is a joint initiative between the Department of Justice and the Department of Health and Human Services.
"Using sophisticated data analysis we can now target suspicious billing spikes," said Daniel Levinson, Health and Human Services' inspector general, in a statement. "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."
Roy, with 10 charges against him – the most of all the accused – faces a maximum of 100 years in prison and millions of dollars in fines and forfeitures.
Roy's lawyer, Patrick McLain, told The New York Times yesterday that he hadn't yet had time to thoroughly examine the indictment but believed the problem resulted in Roy being out of the office visiting patients and having to depend on his employees. "I think that's the problem, is that he just wasn't there," McLain told the newspaper. "If you don't have honest, competent people, that's the problem."
In connection with the indictment against Roy and his associates, the Centers for Medicare & Medicaid Services has suspended 78 home health agencies associated with Roy "based on credible allegations of fraud against them." The Los Angeles Times reports those suspended payments amount to about $2.3 million a month.
Follow HFN associate editor Stephanie Bouchard on Twitter @SBouchardHFN.