Years after Jacques Roy started filing paperwork that would have made his practice the busiest Medicare provider in the U.S., authorities say they've found most of his work was a lie.
They accused Roy on Tuesday of "selling his signature" to collect Medicare and Medicaid payments for work that was never done or wasn't necessary. Others charged in the scheme are accused of fraudulently signing up patients or offering them cash, free groceries or food stamps to give their names and a number used to bill Medicare.
Roy, 41, a doctor who owned Medistat Group Associates in DeSoto, Texas, faces up to 100 years in prison if he's convicted of several counts of health care fraud and conspiracy to commit health care fraud. Six others, including the owners of three home health service agencies, are also charged. More than 75 agencies
linked to Roy have had their Medicare payments suspended.
Roy's attorney, Patrick McLain, said he had yet to review much of the evidence but that Roy maintained his innocence.
A host of top officials from the Justice and Health and Human Services departments announced the investigation Tuesday in Dallas. They argued that the announcement was proof that changes in how Medicare data is analyzed had worked. The scheme was the largest dollar amount by a single doctor uncovered by a task force on Medicare fraud, authorities said.
The officials said years of alleged "off the charts" billing by Roy went unnoticed because they did not have the tools to catch it. Health and Human Services has since beefed up its data analysis and can track other cases, HHS Inspector General Dan Levinson said.
"We're now able to use those data analytic tools in ways - in 2012 and 2011 - that no, we really could not have done in years past," Levinson said.
The department also is working on a system of "predictive modeling" to flag suspicious billings for investigation before they are paid, HHS Deputy Secretary Bill Corr said.
But others still have questions about how a fraud so big could have gone unnoticed for so long.
Patrick Burns, spokesman for the advocacy group Taxpayers Against Fraud, credited HHS for hiring Peter Budetti, CMS' deputy administrator for program integrity, to upgrade its systems. But Burns said the department still had no excuse for missing obvious problems.
"You can't have 11,000 bills from a single doctor if you're the number one home health provider in the nation," Burns said. "You can't see that many patients. It's not physically possible."
