Texans Accused of $375 Million Health Care Fraud

A team of seven Texans led by a Dallas-area doctor were indicted today for allegedly conspiring to commit nearly $375 million in health care fraud, the Centers for Medicare and Medicaid announced.

“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 and Enforcement Action Team] and our Medicare Fraud Strike Force operations,” said Deputy U.S. Attorney General James Cole in a prepared statement.

A tip from a team of data analysts led to the indictment of the seven Texans: Dr. Jacques Roy, a physician who owns the Medistat Group, an association of home health care providers; his office manager; and the owners of five home health agencies. Each could face up to 10 years in prison and a $250,000 fine for conspiracy to commit health care fraud.

According to the indictment, Roy recruited more than 500 home health agencies, which certified more than 11,000 patients to bill for home health services that were either unnecessary or never occurred.

“Dr. Roy and his co-conspirators, for years, ran a well-oiled fraudulent enterprise in the Dallas area, making millions by recruiting thousands of patients for unnecessary services, and billing Medicare for those services,” assistant U.S. Attorney General Lanny Breuer said in a news release.

Only Medicare patients who are home bound qualify for home health services. Officials with CMS said home health agencies are under intense scrutiny when they enroll, because their services are expensive. Millions of dollars in fraudulent billings stacked up over the course of the years-long investigation of Roy and his associates.

“These cases take time to build,” said Ted Doolittle, a deputy director of the CMS Center for Program Integrity. Investigators must go out in teams of two and visit the patients to ensure that they qualify for home health care and receive services billed for by the home health agency. “That’s very painstaking.”