Texas doc convicted in $375M home health fraud scheme

A former Texas doctor has been found guilty of submitting $375 million to Medicare for home health services involving approximately 11,000 patients who ultimately served as a red flag for investigators, according to the U.S. Attorney's Office for the Northern District of Texas.

In what is believed to be the largest healthcare fraud scheme executed by a single doctor, Jacques Roy and his co-conspirators--including three home health agency owners who were also found guilty--offered cash, foodstamps and groceries to patients and then used their information to submit fraudulent home health claims. Recruiters were paid $50 per Medicare beneficiary and often targeted homeless shelters. Roy falsely certified plans of care for these individuals in an office that was essentially a "boiler room," according to prosecutors.

Investigators were tipped off by the sheer volume of Roy's claims, according to the Dallas Morning News. Between 2006 and 2011, Roy submitted claims for approximately 11,000 Medicare patients, far more than any other home health provider in the country.

Even after the Centers for Medicare & Medicaid Services (CMS) suspended Roy in 2011, he created another company, Medcare House Calls, and continued submitting fraudulent bills to Medicare

The home health industry has been vulnerable to fraudulent payments, and federal investigators have responded with stiff sentences. Earlier this year, CMS proposed a preauthorization project in five states to cut down on home health fraud, prompting pushback from providers.

To learn more:
- here's the U.S. Attorney's Office release
- read the Dallas Morning News article

Related Articles:
CMS drafts new rules to limit home health fraud
Home health providers push back against preauthorization proposal
Fraudsters caught in multi-million dollar home health schemes
Homelessness has butterfly effect on healthcare fraud
Feds dole out stiff penalties for home health fraud

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