A Texas doctor was arrested Tuesday for allegedly "selling his signature" to process nearly $375 million in fraudulent Medicare and Medicaid claims in a scheme that was carried on for half a decade; $350 million was improperly billed for Medicare and $24 million for Medicaid. In what is being characterized as one of the largest healthcare scams organized by a single doctor, critics are suggesting that the development only solidifies the fact that the government’s Medicare and Medicaid fraud detection system is gravely flawed.
Federal authorities contend that Jacques Roy of the southwestern Dallas suburb of DeSoto, and six other people, certified 11,000 Medicare recipients through over 500 health providers across a five-year period. But an investigation into Roy’s Medicare practice was not initiated until about a year ago.
The alleged scheme operated from January 2006 to November 2011, though specific dollar amounts as to how the funds were distributed among Roy and his six alleged accomplices are not yet available. "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," U.S. Deputy Attorney General James Cole disclosed during a news conference in Dallas.
The agency that oversees Medicare has two groups of contractors, one that pays claims and another that audits those claims for fraud. But U.S. Health and Human Services (HHS) officials say it is often difficult to track the performance of those contractors assigned to detect Medicare fraud — which is projected to reach $60 billion annually.
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Photo: Dr. Roy's Medistat office at 2617 Bolton Boone Dr., Desoto, Texas