WASHINGTON (Legal Newsline) -- A Dallas physician, his office manager and the owners of five home health agencies have been arrested for allegedly defrauding the government for healthcare services.
The arrests were made Feb. 28, according to the Department of Justice. The amount of the fraudulent transactions total $375 million dollars.
According to the indictment filed in the Northern District of Texas, 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, are each accused of 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 also is charged with three counts of making false statements related to a Medicare claim
The Centers for Medicare and Medicaid Services also announced the suspension of an additional 78 home health agencies associated with Roy because there are credible allegations of fraud.
"The conduct charged in this indictment represents the single largest fraud amount orchestrated by one doctor in the history of HEAT and our Medicare Fraud Strike Force operations," Deputy Attorney General James Cole said. "Thanks to the historic partnerships we've built to combat health care fraud, we are sending a clear message: If you victimize American taxpayers, we will track you down and prosecute you."
HHS Deputy Secretary Bill Corr agreed.
"Thanks to our new fraud detection tools, we have greater abilities to identify the kind of sophisticated fraud scheme that previously could have escaped scrutiny," Corr said. "Our aggressive Medicare Fraud Strike Force operations have enabled us to break up a significant alleged fraud operation and the fraud-fighting authorities in the Affordable Care Act have allowed us to stop further payments to providers connected to this scheme. This case and our new detection tools are examples of our growing ability to stop Medicare fraud."
According to the indictment, Roy owned and operated in the Dallas area a company called Medistat Group Associates P.A. This company was an association of health care providers that primarily provided home health certifications and performed patient home visits.
DOJ claims Roy allegedly certified or directed the certification of more than 11,000 individual patients from more than 500 home health agencies for home health services during the past five years. These certifications allegedly resulted in more than $350 million being fraudulently billed to Medicare and more than $24 million being fraudulently billed to Medicaid by Medistat and home health agencies.
Home health agencie swere used as recruiters so Medistat could bill unnecessary home visits and medical services. Medistat physicians certified and recertified plans so that home health agencies also were able to bill Medicare for home health services that were not medically necessary and not provided. Roy allegedly performed unnecessary home visits and ordered unnecessary medical services.
"Today, the Medicare Fraud Strike Force is taking aim at the largest alleged home health fraud scheme ever committed," Assistant Attorney General Lanny A. Breuer said. "According to the indictment, Dr. Roy and his co-conspirators, for years, ran a well-oiled fraudulent enterprise in the Dallas area, making millions by recruiting thousands of patients for unnecessary services, and billing Medicare for those services. .. ."
"Using sophisticated data analysis we can now target suspicious billing spikes," Health and Human Services Inspector General Daniel R. Levinson said. "In this case, our analysts discovered that in 2010, while 99 percent of physicians who certified patients for home health signed off on 104 or fewer people -- Dr. Roy certified more than 5,000."
Each count of health care fraud carries a maximum penalty of 10 years in prison and a $250,000 fine. Each false statement charge carries a maximum penalty of five years in prison and a $250,000 fine. The indictment also seeks forfeiture of property.