A Canadian doctor bilked America’s health-care program of more than $375-million – the largest-ever scheme to defraud the U.S. Medicare system – according to senior justice officials.
Jacques Roy, the Canadian accused of masterminding the wide-ranging, long-running fraud, was arrested Tuesday in his Rockwall, Texas home. He faces 100 years in prison if convicted. His company, Medistat, operated in the Dallas-Ft. Worth region. Its red and white sign offered ‘home visits’ by primary physicians.
According to the indictment, Dr. Roy, 54, and six others recruited homeless people and others, often with token payments, then claimed they required long-term home health care and billed Medicare and Medicaid, the federal government’s health programs for the elderly and the poor.
“Dr. Roy’s company, Medistat, consisted of just four doctors and approximately fifteen nurses,” said Deputy Attorney General James Cole said in Dallas. “Yet, for the five years covered by the indictment, Dr. Roy’s company is alleged to have certified more Medicare beneficiaries for home health services, and had more beneficiaries under its care, than any other medical practice in the United States.”
In total, billings for more than 11,000 ‘patients’ were submitted by Dr. Roy and his associates.
“This represents the single largest fraud amount orchestrated by one doctor in the history of our Medicare Fraud Strike Force operations,” Mr. Cole said.
The arrest came as Dr. Roy, apparently aware he had become a target for federal investigators, was about to flee, according to government documents. The doctor had created a second – and false – Canadian identity using the name Michel Poulin and was believed ready to head for the Cayman Islands. A copy of a book, Hide Your A$$ET$ and Disappear, was found in his home, as was a guide to registering yachts in the Caymans. Federal investigators said much of the money bilked from Medicare and Medicaid has been sent to bank accounts in the Caribbean islands.
The scale of the operation was stunning. Dr. Roy is alleged to have employed teams of ‘signers’ in a ‘485 Room’– so-called for the ‘Plan of Care’ form that uses that number. Those signers would fill out scores of forms, using names culled from the homeless and others and then affix Dr. Roy’s signature, according to the indictment. Dr. Roy and the other accused co-conspirators also made deals with groups to help recruit ‘patients,’ sometimes paying $50 per individual or agreeing to share the proceeds from billings. Some ‘patients’ were recruited with offers of food stamps; others were given bags of groceries.
Dr. Roy is innocent, according to his lawyer Patrick McLain.
As many as 500 home health-care companies operating in Texas may have dealt with Dr. Roy and his associates. More than 75 have had their Medicare payments suspended as the investigation continues.
Dr. Roy’s seemingly tiny – four doctor – operation was, in terms of billings and patients, the biggest and busiest Medicare billing practice in America, leading some critics to question why it took so long for investigators to notice the massive scale of the operation.
The five-year-long scam had apparently been under investigation for only about a year. At least one of Dr. Roy’s employees, an office manager identified in the indictment only by initials, seems to have been co-operating with law enforcement officials.
“Since 2009, our joint health-care fraud enforcement efforts have recovered a total of more than $10.6-billion in taxpayer funds,” Mr. Cole said, underscoring the enormity of health-care fraud in the United States. “This means that for every dollar Congress has provided for health-care fraud enforcement over the past three years, we have recovered nearly seven dollars.”
Some estimates suggest health-care fraud in the United States costs more than $60-billion annually.