Physician charged in record $375M Medicare, Medicaid scam

Federal officials also charge six others in connection with case

The Obama administration on Tuesday announced that a Texas physician and six others were arrested for allegedly defrauding Medicare and Medicaid of nearly $375 million.

According to administration officials, it is the largest case of home health care fraud ever committed and the biggest case to be brought against a single physician.

Jacques Roy, the physician and owner of Medistat Group Associates, allegedly organized the scheme over the past six years. "Between January 2006 and November 2011, Medistat certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice" in the United States, the Department of Justice and HHS said in a joint statement.

According to investigators, Roy or others certified 11,000 beneficiaries who were recruited by a network of more than 500 home health service agencies, and then billed Medicare for services and home visits that were unnecessary or not provided. Some of the owners are accused of luring beneficiaries into the scheme by offering no-cost health care and other incentives, such as food stamps, in exchange for Medicare identification numbers.

CMS also suspended another 78 home health agencies linked to Roy. The agencies have been collecting about $2.3 million monthly, according to Peter Budetti, CMS' deputy administrator for program integrity (Horowitz, Washington Post, 2/28; Fox, National Journal, 2/28 [subscription required]; AP/New York Times, 2/28; Pecquet, "Healthwatch," The Hill, 2/28).


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