Uncaring homecare con robs Medicare, taxpayers

By James Quiggle
August 8, 2017
Dallas doctor led $375-million Medicare scam claiming healthy seniors were infirm, homebound

imageJacques Roy mounted a form of home invasion, so big and audacious that he’ll serve 35 long and lonely years in federal prison.

The Dallas-area doctor authored one of the largest Medicare cons in history. The elephantine $375-million plot cranked out thousands of false claims for phony care of supposedly infirm and homebound seniors.

Medicare gives seniors a leg up if they’re stuck in their homes, too unhealthy to get around. Uncle Sam pays for specialists to come to their homes and help with their day-to-day medical needs.

Phony home-health claims have robbed Medicare for years. What’s new was Roy’s dark genius for amping up patient recruiting and fake claims to unheard-of levels of industrial efficiency. One more reason Medicare thievery of all kinds could be America’s single largest form of insurance fraud.

Claimed 11,000 seniors in his care

Roy specialized in certifying people for home healthcare benefits, taking this con to new heights. He created a fantasy world, falsely certifying 11,000 seniors as eligible for home healthcare. He convinced Medicare that somehow these seniors were all under his close medical care and supervision.

Roy bribed 500 home-health agencies to pump him with patients he used as fodder for bogus insurance billings. The gang paid many beneficiaries cash, food stamps and groceries to hand over their Medicare identifiers. The seniors’ personal information such as SSN was rocket fuel for his con.

Roy falsely certified the seniors for homecare. He received a slice of fake claims the home agencies billed, and soaked Medicare for his own home visits as the supervising doctor. Roy even set up a boiler room where employees worked all day robo-signing his name on Medicare claims.

Cronies ran home-health agencies in the Dallas area. They helped Roy convince Medicare that often-homeless street people were eligible for home-health visits. Or that perfectly healthy, mobile seniors were bedridden and needed homecare.

Some knocked on doors, convincing healthy seniors to hand over their Medicare and other personal information for Roy. They also pulled in homeless seniors off the streets, for example. One crony often bribed cohorts $50 per beneficiary they found and sent to her vehicle parked outside a Dallas homeless shelter’s gates. She promised the homeless people free McDonald’s meals for their medical information.

Forged patient care plans

Roy’s network also invented medical records to make it seem the seniors qualified for home healthcare. They forged patient care plans, and helped dummy up daily logs supposedly documenting hundreds of worthless or phantom patient-care visits.

This frenetic activity let Roy and the collaborating home-health agencies pour bills into Medicare under the happy illusion of homebound seniors getting care they needed, under the watchful eye of a physician.

Roy was bound to attract attention. On paper, he ran the largest home-health operation in the U.S. — dozens of times more than any specialist practitioner.

Medicare got wind and started investigating. Investigators found healthy seniors mowing their lawns and working on cars in their driveways. Roy was handed 35 years in federal prison, and must repay more than $268 million

The welcome mat for Roy’s uncaring homecare plot was yanked, replaced with a lock and key that will keep the conspirators, well, homebound in jail for years to come.

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