Rockwall, Texas-based doctor Jacques Roy, MD, was sentenced Wednesday by U.S. District Judge Sam A. Lindsay to 35 years in federal prison for his involvement in a $374 million home health care fraud scheme, the Department of Justice (DOJ) announced. The scheme, which prosectors deemed “staggering,” is the largest home health care fraud case in the history of the United States.
In addition to his prison sentencing, Roy has also been ordered to pay roughly $268 million in restitution, joint and several, with all codefendants to Medicare and Medicaid, according to U.S. Attorney John Parker of of the Northern District of Texas.
Roy was convicted last April of one count of conspiracy to commit health care fraud; eight counts of health care fraud; two counts of falsifying statements relating to health care matters; and one count of obstruction of justice.
Roy, along with co-conspirators Wilbert James Veasey, Jr.; Cynthia Stiger; Charity Eleda; and others, colluded to defraud Medicare and Medicaid through companies that they owned/controlled: Medistat Group Associates, P.A.; Apple of Your Eye Health Care Services, Inc.; Ultimate Care Home Health Services and Charry Home Care Services.
As part of the scheme, Stiger, Veasey and Eleda, with the help of associates, “improperly recruited” individuals with Medicare coverage to sign up for Medicare home health care services, according to the DOJ. Eleda—who sometimes even paid recruiters $50 for every beneficiary they signed up—forged medical documents as proof the beneficiaries were qualified to receive home health care services that were not medically necessary.
Eleda and her associates would prepare Plans of Care (POCs) for these patients, which were then delivered to Roy, who ordered his staff to certify the POCs—signifying to Medicare and Medicaid that a doctor had reviewed the plan and determined services medically necessary.
Once a patient was approved for home health care services, Eleda, and nurses who worked for Stiger and Veasey, would falsify visit notes detailing that skilled nursing services were being administered and continued to be necessary; for his part, Roy would perform unnecessary home visits and order superfluous medical services. Roy also had his employees at Medistat submit false claims to Medicare for the certification and re-certification of unneeded home health care/medical services.
Evidence presented at trial showed that Roy and Medistat processed and approved POCs for 11,000 unique beneficiaries from than 500 different home health agencies.
When the Centers for Medicare and Medicaid Services learned of Roy’s suspected fraud, the agency suspended Medicare payments to Roy and Medistat. Roy, however, circumvented this suspension by having the medical providers he employed be re-credentialed and to bill Medicare under another company, Medcare House Calls, from which he would funnel payments from back to Medistat.
Veasey and Eleda were convicted in June for their involvement; both have been sentenced to serve 10 years and four years in federal prison, respectively, as well as paying restitution.
Stiger is awaiting her sentencing on October 26.
Written by Carlo Calma