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Texas doctor accused of largest Medicare, Medicaid fraud scheme in US history

Saturday, March 10, 2012 by: Jonathan Benson, staff writer
Tags: Medicare, fraud, doctors

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(NaturalNews) Medicare and Medicaid, the two largest government-run health care programs that cover health services for elderly, disabled, and low-income individuals, cost taxpayers tens of billions of dollars a year just in fraudulent claims. And an ongoing crackdown on such fraud being undertaken by the U.S. Department of Justice (DOJ) and the U.S. Department of Health and Human Services (HHS) has revealed perhaps the largest single-person case of Medicare and Medicaid fraud in U.S. history.

Jointly established by both DOJ and HHS to investigate such matters, the Health Care Fraud Prevention and Enforcement Action Team (HEAT) has exposed a massive health care fraud scheme in Texas that involves $375 million in stolen taxpayer dollars. Dr. Jacques Roy had reportedly been operating a practice called Medistat Group Associates in DeSoto, Tex., where he allegedly engaged in routine acts of fraud, which included paying poor and homeless individuals cash sums in exchange for them agreeing to use their names to file bogus Medicare and Medicaid claims.

According to CBS News, Roy is also accused of "selling his signature" to file phony claims, which included hiring recruiters to go around the community in search of willing individuals to participate in various conspiracies to commit health care fraud. Part of this scheme involved billing the government for unnecessary, and typically expensive, home health services like in-home nursing care and physical therapy.

W. Rick Copeland, Director of the Medical Fraud Control Unit of the Office of the Texas Attorney General explained at a recent conference how the scheme worked, as it involved several home health service agencies as well as more than 75 agencies with which Roy was involved. If convicted, Roy faces up to 100 years in prison on several counts of health care fraud and conspiracy to commit health care fraud.

"You can't have 11,000 bills from a single doctor if you're the number one home health provider in the nation," said Patrick Burns, a spokesman from the consumer advocacy group Taxpayers Against Fraud, concerning the co-conspirators that he believes should have known that Roy was running a racket. "You can't see that many patients. It's not physically possible."

Big Pharma has bilked even more money from Medicare, Medicaid than Roy

Doctors are not the only ones involved in bilking taxpayers out of billions of dollars via the U.S. government, though. A new report explains that the drug industry has already had to pay out more than $8 billion for fines levied for Medicare and Medicaid fraud -- and this represents just the fraud that has thus far been discovered (http://www.usatoday.com).

Representing far more than the amount stolen by Roy, this $8 billion in collective fines covers the fraudulent health care schemes devised by the likes of Pfizer, Merck & Co., and GlaxoSmithKline, all of which have committed much worse acts of fraud. And yet, unlike Roy, these companies remain in business and their executives not in prison because they "are often the sole suppliers of critical products," according to USA Today.

That Roy could spend the rest of his life in prison while drug company executives walk free illustrates the blatant double standard in the American justice system. Drug companies are apparently "too important to fail," and are simply required to pay out a portion of their plunder in the form of fines when they get caught for fraud, while everyone else faces life in prison.

Sources for this article include:




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