7 Charged in $375 Million Fraud Scheme'Largest Alleged Home Health Fraud Scheme Ever'
Federal officials have arrested and charged seven people, including a physician, the office manager of his medical practice, and five owners of home health agencies in the Dallas area, for their alleged role in a nearly $375 million Medicare and Medicaid fraud scheme.
Assistant Attorney General Lanny A. Breuer says the case is the "largest alleged home health fraud scheme ever committed." Those charged "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," he adds.
The indictments charge Jacques Roy, M.D., Cynthia Stiger, Wilbert James Veasey Jr., Cyprian Akamnonu, Patricia Akamnonu, Teri Sivis and Charity Eleda with one count of conspiracy to commit healthcare fraud. Roy is also charged with nine counts of substantive healthcare fraud. Veasey, Patricia Akamnonu and Eleda are each charged with three counts of healthcare fraud, and Eleda is also charged with three counts of making false statements related to a Medicare claim.
The indictments, announced by the Department of Health and Human Services, state that Roy owned and operated Medistat Group Associates P.A. in the Dallas area, which was an association of healthcare providers that provided home health certifications and performed patient home visits. "Dr. Roy allegedly certified or directed the certification of more than 11,000 individual patients ... for home health services during the past five years," according to a statement issued by HHS.
The Centers for Medicare & Medicaid Services also suspended an additional 78 home health agencies associated with Roy based on credible allegations of fraud.
The scheme was discovered through sophisticated data analysis, which brought to light suspicious billing spikes, says HHS Inspector General Daniel R. Levinson. "In this case, our analysts discovered that in 2010, while 99 percent of physicians who certified patients for home health signed off on 104 or fewer people, Dr. Roy certified more than 5,000," he says.
Between January 2006 and November 2011, "Medistat certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States," according to the HHS statement. The certifications allegedly resulted in more than $350 million being billed fraudulently to Medicare, with more than $24 million being fraudulently billed to Medicaid.