Texas Doctor Bilks Medicare/Medicaid for $375,000,000

In what is believed to be the biggest dollar amount scheme committed by a single doctor, Jacques Roy, who owned Medistat Group Associates in DeSoto, Texas, and six others have been indicted on charges of bilking Medicare and Medicaid out of $375 million in phony or unnecessary home visits between January 2006 and November 2011.

According to the indictment, Medistat certified more patients than any other medical practice in the United States during the five-year period the alleged fraud occurred. The 11,000 approvals amount to a whopping 500 times the number of home-health certifications than the average doctor.

The small, four-doctor practice allegedly found its patients by paying home health agency recruiters $50 per beneficiary they found by canvassing a Dallas homeless shelter and by offering free healthcare or food stamps to anyone who signed up and offered their Medicare number. Roy would then “make home visits to that beneficiary, provide unnecessary medical services and order unnecessary durable medical equipment for that beneficiary,” the indictment alleged. “Medistat would then bill Medicare for those visits and services.”

According to HHS, the department did not have the tools to detect the type of anomaly that spurred investigation until recently. “We’re now able to use those data analytic tools in ways–in 2012 and 2011–that no, we really could not have done in years past,” the department’s Inspector General, Dan Levinson, told The Washington Post.

Following the Roy investigation, HHS suspended payments totaling $2.3 million per month to 78 home healthcare agencies in Texas that are suspected of billing irregularities, The Wall Street Journal reported.

Roy has been charged with nine counts of healthcare fraud and one count of conspiracy to commit healthcare fraud. He could face 100 years in prison and a fine of at least $18.5 million, if convicted.