The FBI has wrapped up the largest ever home health care fraud case, which centered around a $374 million scheme in Texas and involved seven individuals, the agency stated in a post on Monday.
The sentencing of Cynthia Stiger, 52, of Dallas, in October to 10 years in prison marked the end of the major fraud case, which spanned eight years and involved thousands of patients, according to a summary from the FBI.
“It was the largest single-physician home health care fraud in the country,” Special Agent Chelsie Drews, who investigated the case from the FBI’s Dallas Division, said in the FBI’s post.
In addition to the thousands of patients, Dr. Jacques Roy, the ringleader, certified patients for Medicare home health services from more than 500 home health companies. “Those kinds of numbers were unheard of in the industry,” Drews said in the FBI summary.
Stiger, who was one of seven defendants, was also ordered to pay more than $23 million in restitution to Medicare and Medicaid. Stiger and others improperly recruited individuals with Medicare coverage to sign up for home health care services.
Roy received a sentence of 35 years in August for his role in the scheme, and was ordered to repay more than $268 million in joint and several restitution to Medicare and Medicaid.
Under the scheme, the conspirators falsified medical documents and created medically unnecessary plans of care (POC) to make it look as though Medicare patients qualified for home health care services, according to the FBI. Another conspirator, Charity Eleda, a nurse who was a co-owner of Charry Home Care Services, Inc., sometimes paid recruiters $50 for each Medicare eligible patient, seeking out patients at homeless shelters, the agency said.
Roy would instruct staff to certify the POCs, which indicated to Medicare and Medicaid that a doctor—most often Roy—found the plan medically necessary, certifying the patient for home health services.
At one point, the Centers for Medicare and Medicaid Services (CMS) learned of Roy’s suspected fraud and suspended payments to him and to Medistat Group Associates, one of the companies controlled by the conspirators. He dodged the suspension after the medical providers under his employment were re-credentialed, and he billed under the company Medcare House Calls. From there, Roy would move payments back to Medistat.
The evidence indicated that Roy approved plans of care for 11,000 unique Medicare beneficiaries.
Over the course of the scheme, fraudulent claims worth hundreds of millions of dollars were submitted to Medicare, and many patients either did not receive care or received inferior care, the FBI said.
Roy and the others were arrested in 2012 on various health care fraud charges.
Written by Maggie Flynn