Federal officials said Tuesday they have unearthed the largest Medicare fraud scheme ever discovered and arrested a ring of Dallas-area health care professionals on suspicion of collecting $375 billion for phony medical claims.
Dr. Jacques Roy is charged as owner and operator of Medistat Group Associates — an association of home-health care providers who recruited patients, certified them for care they didn't need and never received, and then billed Medicare millions of dollars over a six-year period, officials said.
"Today, the Medicare Fraud Strike Force is taking aim at the largest alleged home-health fraud scheme ever committed," said Lanny Breuer, assistant attorney general for the U.S. Justice Department's criminal division. "According to the indictment, Dr. Roy and his co-conspirators, for years, ran a well-oiled fraudulent enterprise."
The 54-year-old doctor allegedly set up a "485 Department" where employees added his signature to thousands of care plans, naming the department after the number of the Medicare form where the plan of care is documented.
Some of the care plans belonged to Cyprian Akamnonu, another provider who paid cash in exchange for a doctor's signature to ensure Medicare would reimburse him, officials said. In another instance, according to authorities, provider Charity Eleda visited a homeless shelter to recruit patients, where she paid recruiters $50 for each person they directed to her vehicle parked outside the shelter's gates.
Along with Dr. Roy, Medistat office manager Teri Sivils and five owners of home health-care practices are facing charges in federal court related to health-care fraud.
Secretary of Health and Human Services Kathleen Sebelius applauded the arrests Tuesday afternoon, saying they were evidence that a joint effort between the Department of Justice and HHS to find and prosecute fraud is working. But she said there's still a need to find new tools that make it harder for providers to commit fraud.
"There are a number of strategies," she said, speaking before the House Ways and Means Committee. "[We're] looking at a different kind of Medicare card that would be less easy to access or less easy to steal or share."
Earlier this month, the administration announced that its efforts to prevent fraud saved the Medicare program $4.1 billion last year — almost twice the $2.14 billion in phony claims collected in 2008. At the same time, 75 percent more individuals were charged with fraud, officials said.
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