Texas Doctor Bills Medicare for Nearly $400 Million in Large-Scale Fraud, Forgery Scheme

In an exceptionally heinous example of home healthcare fraud, seven doctors have been apprehended for their roles in a conspiracy to defraud both Medicare and Medicaid alike. Altogether, they have been ordered to pay over $342 million in restitution to recover the money bilked by the extensive false claims submitted over the course of the five-year scheme. Most of the egregious crimes revolve around one physician, Jacques Roy, who employed various sophisticated and devious tactics in order to successfully rob the government healthcare programs.

Roy, along with several others, owned and controlled several different home healthcare facilities, namely:

  • Medistat Group Associates
  • Apple of Your Eye Healthcare Services, Inc.
  • Ultimate Care Home Health Services
  • Charry Home Care Services

Through these companies, Roy handled more home health care visits than any other physician’s office nationwide. Purportedly, over 11,000 Medicare beneficiaries were certified and treated from January 2006 to November 2011 – a widely unrealistic number, if care was provided as it should have been.

However, that was clearly not the case. During the investigation, it was discovered that not only were patients being certified as requiring services that were not medically necessary, but Roy and his partners were frequenting Dallas-area homeless shelters in order to recruit Medicare beneficiaries to receive treatment from his facilities. The team would pay recruiters up to $50 per “patient.” The recruiters would then bribe those living in the shelter with promises of cash, food stamps, and groceries if they agreed to be seen and treated. From there, Roy instructed his nurses to falsify medical records to certify that these bogus patients genuinely required home healthcare services.

In order to certify such a claim, these patients would have to be physically seen by a physician, typically Roy, who would then review a treatment plan in order to determine if the patient is truly in need of such care – one of the requirements being that a patient is homebound or unable to ambulate. Due to the incredible influx of patients on any given day, Roy set up a full-time forgery operation to circumvent this process. He trained a team of nurses and billing specialists to affix his signature to medical documents and, in doing so, was able to bill Medicare and Medicaid for thousands of individuals who did not qualify for this level of care under federal guidelines.

Unreasonable amounts of patient care visits were logged on any given day through the four home care companies, easily soaring into the hundreds; Roy himself claimed to have seen up to fifteen patients a day during the height of the scam. For the purposes of perpetuating this scheme, he and his team entered into fraudulent relationships with over 500 home health care agencies to ensure that he had consistent access to recruitable Medicare beneficiaries, oftentimes offering kickbacks to facilities and practitioners alike.

Although this case was certainly one of the largest home healthcare fraud schemes involving a single physician, others like this are not unheard of. Those who blindly pursue financial gain at the expense of the nation’s most elderly and ailing tend to stop at nothing in order to continue bilking government healthcare systems. The apprehension of these brazen individuals, as well as the funds that were recovered, are considered to be a huge win for the government as well as a clear demonstration of the efforts taken by the Medicare Strike Force to uncover and ultimately prevent further fraudulent activity.

Whistleblower Justice Network Can Help You

Whistleblower Justice Network partners with whistleblowers in a diligent attempt to expose any suspicious activity that jeopardizes the well-being of patients and defrauds any of the various government healthcare programs. We believe that those who prioritize the depth of their pockets to the quality of patient care should be swiftly brought to justice, and seek to work with those who agree.

If you have meaningful information regarding any type of healthcare fraud that you believe is in violation of the False Claims Act, Anti-Kickback Statute, or Stark Law, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.