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Last updated on April 23, 2014 at 12:22 EDT

Health Integrity Investigation Leads to Landmark Indictment

March 12, 2012

DALLAS, March 12, 2012 /PRNewswire-USNewswire/ — A three-year-long investigation spearheaded by Health Integrity culminated February 28 in the arrest of Dr. Jacques A. Roy on charges of healthcare fraud totaling an estimated $350 million.

In addition, services at 78 home health agencies were suspended throughout the Dallas-Ft. Worth area in connection with the case.

Roy was indicted February 27 on charges of misrepresentation of services, billing for services not rendered or provided by an unlicensed physician and forging provider referral statements.

“This is a shining example of teamwork,” said David Duhaime, Zone Program Integrity Contractor (ZPIC) Program Director for Health Integrity. “By combining the efforts of the Centers for Medicare & Medicaid Services’ contractors and law enforcement at both the federal and local levels, we scored a win for the American taxpayer.”

Health Integrity inherited the incomplete Program Safeguard Contractor (PSC) investigation in February 2009 when the newly formed Zone Program Integrity Contract (ZPIC) became operational. Utilizing all available Medicare data and more advanced data analytics, Health Integrity’s ZPIC analysts identified a high volume of referrals to home health agencies. Investigators interviewed patients, providers and agency owners, and determined the majority of care recipients neither qualified for services nor had any knowledge of Dr. Roy.

Less than a year after assuming the responsibilities of the investigation as a ZPIC, Health Integrity forwarded the findings in January 2010 to the Health and Human Services Office of the Inspector General who then initiated a federal investigation.

About Health Integrity, LLC

Health Integrity, a wholly-owned subsidiary of Quality Health Strategies, Inc., is dedicated to protecting the fiscal and clinical integrity of healthcare systems. The company operates nationally as a federally-designated program integrity contractor for the Centers for Medicare & Medicaid Services (CMS). Health Integrity’s expert clinical and technical staff use data analysis and advanced technology to identify and investigate potential fraud, waste, and abuse in healthcare – aiding law enforcement agencies and protecting public resources.

SOURCE Health Integrity, LLC


Source: PR Newswire