Feds Allege Monster Health Care Fraud

DALLAS (CN) – Federal prosecutors accuse a Dallas-area doctor of masterminding the biggest home health-care fraud in history: a conspiracy that fraudulently billed Medicare and Medicaid for more than $350 million.



     Dr. Jacques Roy is lead defendant in a complaint that also names as defendants his his office manager and five home health agency owners.
     The Department of Justice called it “the largest alleged home health fraud scheme ever committed.”
     Prosecutors filed a memo on Tuesday asking that Roy be detained pending trial. The memo states: “Defendant Jacques Roy, M.D., (‘Dr. Roy’) masterminded and executed a health care fraud conspiracy that resulted in well over $350 million being fraudulent(ly) billed to the Medicare and Medicaid programs over the past five years. The evidence of Dr. Roy’s guilt is strong and he faces a life sentence if convicted. He has shown a brazen disregard for legal and administrative process by reconstituting his fraud scheme under the guise of another company after being places on suspension from the Medicare program in 2011. And perhaps most importantly, Dr. Roy has created a false identity and squirreled away millions of dollars of assets that likely would be available to him should he choose to flee. The United States moves this Court, pursuant to the Bail Reform Act, to detain Dr. Roy pending trial because he is a flight reish and a danger to the community.”
     Here are the defendants in the federal indictment, which was unsealed on Tuesday:
     Jacques Roy, M.D., 54, of Rockwall, Texas; Cynthia Stiger, 49, of Dallas; Wilbert James Veasey Jr., 60, of Dallas; Cyprian Akamnonu, 63, of Cedar Hill, Texas; Patricia Akamnonu, RN, 48, of Cedar Hill; Teri Sivils, 44, of Midlothian, Texas; and Charity Eleda, RN, 51, of Rowlett, Texas.
     Each is charged with one count of conspiracy to commit health care fraud.
     Roy also is charged with nine counts of substantive health care fraud.
     Veasey, Patricia Akamnonu and Eleda are each charged with three counts of health care fraud.
     Eleda is calso harged with three counts of making false statements in a Medicare claim.
     Federal officials announced that 78 home health agencies that have done business with Roy have been suspended from Medicare and Medicaid programs based on “credible allegations of fraud.”
     The indictment claims the defendants recruited more than 11,000 patients from more than 500 home healthcare agenices (HHAs) to bill Medicare and Medicaid for unnecessary home visits for medical services.
     Roy owned and operated Medistat Group Associates P.A., which provided home health certifications and performed patient home visits. He is accused of using the HHAs as recruiters from January 2006 to November 2011.
     Prosecutors said Medistat certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States.
     Three of the HHAs Roy used in the scheme were Apple of Your Eye Healthcare Services, owned and operated by Stiger and Veasey; Ultimate Care Home Health Services, owned and operated by Cyprian and Patricia Akamnonu; and Charry Home Care Services, owned and operated by Eleda, according to the indictment.
     Eleda allegedly visited The Bridge Homeless Shelter in Dallas to recruit homeless people, and paid recruiters $50 a head for people they found at The Bridge and sent to Eleda’s vehicle parked outside the shelter’s gates.
     Apple allegedly submitted $9.2 million in claims to Medicare for home health services that were medically unnecessary and not provided. Roy or another Medistat physician certified the services, prosecutors said.
     Ultimate Care Home Health Services is accused of submitting $43.2 million in claims for medically unnecessary home health services.
     Charry is accused of submitting $468,858 in fraudulent claims for medically unnecessary services that were not provided.
     Each count of conspiracy to commit health care fraud and substantive health care fraud is punishable by up to 10 years in prison and a $250,000 fine.
     Each false statement charge is punishable by up to years in prison and a $250,000 fine.
     The indictment also seeks forfeiture of money in bank accounts, a sailboat, vehicles and multiple properties.

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