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Seven Indicted in $375 Million Texas Health Care Fraud Scheme

A Dallas doctor and his office manager, along with five owners of Dallas-area home health agencies have been indicted on charges alleging they bilked Medicare and Medicaid for nearly $375 million dollars for home health services that were not medically necessary or were not performed.

The U.S. Department of Health & Human Services reports that the indictment, filed in the Northern District of Texas, charges Jacques Roy, M.D. and six others, including his office manager, with one count of conspiracy to commit health care fraud. Roy is additionally charged with nine counts of substantive health care fraud and three counts of making false statements related to a Medicare claim.

The indictment provides that 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. Assistant Attorney General Lanny A. Bruer states that "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."

Roy allegedly paid "recruiters" to find people to bill for home health services, which included visiting Dallas homeless shelters to recruit homeless beneficiaries staying at the facility. Medistat certified more beneficiaries and had more patients than any other medical practice in the United States. Over 11,000 individual patients and 500 home health services were certified or directed to be certified by Dr. Roy, resulting in over $375 million to be fraudulently billed by Medicare and Medicaid.

According the Deputy Attorney General James Cole, "the conduct charged in [the] 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 Medicare Strike Force Operations."

Medicare fraud schemes such as the one alleged in this action, are estimated to cost taxpayers over $60 billion each year. The civil False Claims Act provides for liability for triple damages and $5,000 to $11,000 per claim for anyone who knowingly submits or causes the submission of a false or fraudulent claim to the United States (such as claims for Medicare or Medicaid reimbursement). Under the False Claims Act, a private person, known as a relator (or whistleblower) may file a "qui tam" action on the behalf of the government, where that person has knowledge that the named defendant has knowingly submitted such claims to the federal government. If there is a settlement or judgment in the relator's qui tam action, the relator may be entitled to an award of up to 25 percent of the total amount recovered by the government.

Qui tam actions under the False Claims Act differ greatly from other fraud actions and are extremely complex and extensive. Dreyer Boyajian LLP is experienced in representing qui tam relators in false claims actions and is currently handling several cases involving Medicare and/or Medicaid fraud.  If you are aware of any false or fraudulent claims being submitted to the government, contact our office for a free consultation with one of our attorneys.

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