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Last updated on April 17, 2014 at 17:30 EDT

Largest Healthcare Fraud In US History

February 29, 2012

Texas doctor, 6 others indicted in $375 million Medicare/Medicaid scheme

A Texas physician and six others were indicted on Tuesday in the largest healthcare fraud case in U.S. history, federal law enforcement officials reported.

The massive scheme allegedly robbed Medicare and Medicaid of $375 million.

According to the indictment, Dr. Jacques Roy, owner of Medistat Group Associates in DeSoto, Texas, led a scheme that billed Medicare for home health services that were not medically necessary or were never delivered.  The federal indictment also charges Dr. Roy with creating a false identity and sending funds offshore with the intention of fleeing the country.

Dr. Roy´s office manager and five owners of home health agencies (HHAs) were also indicted.

The documents, filed in the Northern District of Texas and unsealed Tuesday, charge Jacques Roy, M.D., 54, of Rockwall, Texas; Cynthia Stiger, 49, of Dallas; Wilbert James Veasey Jr., 60, of Dallas; Cyprian Akamnonu, 63, of Cedar Hill, Texas; Patricia Akamnonu, RN, 48, of Cedar Hill; Teri Sivils, 44, of Midlothian, Texas; and Charity Eleda, RN, 51, of Rowlett, Texas, each with one count of conspiracy to commit health care fraud.

Dr. Roy is also charged with nine counts of substantive health care fraud, and Veasey, Patricia Akamnonu and Eleda are each charged with three counts of health care fraud.  Eleda also is charged with three counts of making false statements related to a Medicare claim.

The indictment alleges that from January 2006 through November 2011, Dr. Roy or others certified more Medicare beneficiaries for home health services and had more patients than any other medical practice in the country.

These certifications allegedly resulted in more than $350 million being fraudulently billed to Medicare, and more than $24 million being fraudulently billed to Medicaid by Medistat and other HHAs.

The Centers for Medicare and Medicaid Services also announced the suspension of an additional 78 home health agencies associated with Roy based on credible allegations of fraud against them.

U.S. Attorney Sarah Saldana said that Dr. Roy used the home health agencies as “his soldiers on the ground to go door to door to recruit Medicare beneficiaries.”

“The conduct charged in this indictment represents the single largest fraud amount orchestrated by one doctor in the history of HEAT and our Medicare Fraud Strike Force operations,” said Deputy Attorney General James Cole.

HEAT is a joint initiative between the Departments of Justice and Health and Human Services to prevent and deter fraud and enforce anti-fraud laws across the country.

The indictment alleges that Medistat maintained a “485 Department,” named for the number of the Medicare form on which the plan of care was documented.  Dr. Roy allegedly instructed Medistat employees to complete the 485s by either signing his name by hand or by using his electronic signature on the document.

Three of the HHAs Dr. Roy used as part of the scheme were Apple of Your Eye Healthcare Services Inc., owned and operated by Stiger and Veasey; Ultimate Care Home Health Services Inc., owned and operated by Cyprian and Patricia Akamnonu; and Charry Home Care Services Inc., owned and operated by Eleda.

According to the indictment, Veasey, Akamnonu, Eleda and others recruited beneficiaries to be placed at their HHAs so that they could bill Medicare for the unnecessary and not provided services.  As part of her role in the scheme, Eleda allegedly visited The Bridge Homeless Shelter in Dallas to recruit homeless beneficiaries staying at the facility, paying recruiters $50 per beneficiary they found at The Bridge and directed to Eleda´s vehicle parked outside the shelter´s gates.

Apple allegedly submitted claims to Medicare from Jan. 1, 2006, through July 31, 2011, totaling $9,157,646 for home health services to Medicare beneficiaries that were medically unnecessary and not provided.  Dr. Roy or another Medistat physician certified the services.

From Jan. 1, 2006, to Aug. 31, 2011, Ultimate submitted claims for medically unnecessary home health services totaling $43,184,628.  Charry allegedly submitted fraudulent claims from Aug. 1, 2008, to June 30, 2011, totaling $468,858 in medically unnecessary and not provided home health services.

The indictment alleges that Sivils, as Medistat´s office manager, helped facilitate the fraud scheme by, among other actions, supervising the processing of thousands of plans of care that contained Dr. Roy´s electronic signature and other Medistat physicians´ signatures, permitting HHAs to bill Medicare for unnecessary home health services and accepting cash payments from Cyprian Akamnonu in exchange for ensuring plans of care contained Dr. Roy or another Medistat physician´s signature.

As outlined in the government´s request to the court to detain Dr. Roy, in June 2011, the Centers for Medicare and Medicaid Services suspended provider numbers for Dr. Roy and Medistat based on credible allegations of fraud, thus ensuring Dr. Roy did not receive payment from Medicare.

Immediately after the suspension, nearly all of Medistat´s employees started billing Medicare under the provider number for Medcare HouseCalls.

The court document alleges that Dr. Roy was in fact in charge of day-to-day operations at Medcare, and that Dr. Roy continued to certify patients for home health despite the suspension.

Each charged count of conspiracy to commit health care fraud and substantive health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine.  Each false statement charge carries a maximum penalty of five years in prison and a $250,000 fine.

The indictment also seeks forfeiture of numerous items including funds in bank accounts, a sailboat, vehicles and multiple pieces of property.

The case is being prosecuted by Assistant U.S. Attorneys Michael Elliott, Mindy Sauter and John DeLaGarza of the Northern District of Texas and Trial Attorney Ben O´Neil and Deputy Chief Sam Sheldon of the Criminal Division´s Fraud Section.

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Source: RedOrbit Staff & Wire Reports