Federal officials crack $375 million home healthcare fraud scheme

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Antisocial behavior best predictor of abuse among residents with criminal history, analysis says
Antisocial behavior best predictor of abuse among residents with criminal history, analysis says

Federal officials have brought down what they said is the largest home health fraud scheme ever concocted.

The Centers for Medicare & Medicaid Services said around $375 million was billed incorrectly to Medicare and Medicaid, and announced the suspension of 78 home health agencies associated with physician Jacques Roy, M.D., of Rockwall, TX. Roy, his medical practice office manager, and five home health agency owners were indicted Tuesday and face various counts of healthcare fraud.

Roy owned and operated a home health certification group called Medistat Group Associates, P.A. He allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 home health agencies over five years. In 2010 alone, he certified more than 5,000 patients, whereas 99% of physicians who certify patients for home health signed off on around 100 people, HHS Inspector General Daniel Levinson said. Prosecutors say that Roy used the home health agencies as recruiters, and that Medistat billed for both unnecessary home visits and medical services, and for services that were never given. Federal officials said this is the biggest home healthcare fraud plot to be orchestrated by one physician.

The case is being prosecuted by Assistant U.S. Attorneys Michael C. Elliott, Mindy Sauter and John DeLaGarza of the Northern District of Texas, trial attorney Ben O'Neil and Deputy Chief Sam S. Sheldon. Click here for more information about Medicare fraud.