Texas doctor caught in a $375 million fraud

A Texas doctor has been accused of running a massive health fraud care scheme with thousands of fraudulent patients and intermediaries allegedly offering cash, food stamps or free groceries, to cheat the Medicare and Medicaid of nearly $375 million.

A federal indictment this Tuesday charges Jacques Roy, a doctor who owned Medistat Group Associates in DeSoto, Texas, and six others in an alleged scheme to bill Medicare for home health services that were not properly billed, not medically necessary or not done. The scheme was the largest dollar amount by a single doctor uncovered by a task force on Medicare fraud, authorities said. U.S. Attorney Sarah Saldana accused Roy of “selling his signature” to home health agencies that rounded up thousands of patients' names and billed Medicare and Medicaid for five years. Saldana said Roy used the home health agencies as “his soldiers on the ground to go door to door to recruit Medicare beneficiaries.” “He was selling his signature,” she said.

The indictment alleged that from January 2006 through November 2011, Roy, 54 or others certified 11,000 Medicare beneficiaries for more than 500 home health service agencies — more patients than any other medical practice in the U.S. More than 75 of those agencies have had their Medicare payments suspended.

Roy faces up to 100 years in prison if convicted on all counts of health care fraud and conspiracy to commit health care fraud. He appeared briefly in court Tuesday and is scheduled to have a detention hearing Wednesday. Authorities also moved to seize cash in Roy's bank accounts, cars and two sailboats.

His attorney, Patrick McLain, said authorities had contacted Roy months ago. McLain said it was too soon to comment on the case because prosecutors hadn't provided him with most of the evidence yet.

Investigators for the U.S. Health and Human Services department noticed irregularities with Roy's practice about one year ago, officials said.

The Centers for Medicare and Medicaid Services also announced the suspension of an additional 78 home health agencies associated with Roy. The agencies were collecting about $2.3 million a month, said Peter Budetti, CMS' deputy administrator for program integrity. The alleged fraud went unnoticed for several years. After CMS suspended Medicare provider accounts belonging to Roy and Medistat last July, Medistat's employees allegedly started billing Medicare under a different provider number under Roy's supervision, authorities said.

The Obama administration has said it’s cracking down on those who steal from the government health programs for the elderly, poor and disabled. There are no reliable figures for how much government health programs lose to fraud annually. Senator Tom Coburn, an Oklahoma Republican, estimates the Medicare loss from fraud, waste and abuse at $60 billion to $100 billion annually, according to his spokesman, John Hart.

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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