Physician Arrested in Largest Health Care Fraud Case in US History

The FBI arrested Jacques Roy, MD of Rockwell, Texas on charges that he defrauded Medicare for nearly $375 million in billings for nonexistent home health care services since 2006, according to a press release from the Centers for Medicare & Medicaid. Justice department officials, in what is being called the largest health care fraud case in US history, also said that 78 home health agencies collaborating with Roy will be suspended from Medicare for up to 18 months.

Roy and his office manager, Teri Sivils, who was also charged in the case, sent recruiters door to door asking residents to sign forms containing the doctor’s electronic signature. These forms stated that Roy had seen these residents professionally for medical services he never provided. It is also alleged that Roy went to a homeless shelter in Dallas and paid $50 to any resident of the shelter who signed the forms, according to an additional report from the Los Angeles Times.

According to the indictment, Roy owned and operated Medistat Group Associates P.A. in the Dallas area. Medistat was an association of health care providers that primarily provided home health certifications and performed patient home visits. Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 HHAs for home health services during the past 5 years. Between January 2006 and November 2011, Medistat certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States, according to the CMS report. These certifications allegedly resulted in more than $350 million being fraudulently billed to Medicare and more than $24 million being fraudulently billed to Medicaid by Medistat and HHAs.

Roy, who has been a physician for 28 years, is facing life in prison, a $250,000 fine and restitution of a large amount of the money he allegedly stole from the government. The indictment also seeks forfeiture of numerous items including funds in bank accounts, a sailboat, vehicles and multiple pieces of property, according to the release.

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

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