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1 Doc Accused Of Bilking Medicare For $375M

From the Associated Press:

7 accused of bilking $375M from Medicare, Medicaid

February 29, 2012

DALLAS (AP) — A Texas doctor has been charged with running a massive health fraud care scheme with thousands of fraudulent patients and intermediaries allegedly offering cash, food stamps or free groceries, to bilk Medicare and Medicaid of nearly $375 million.

That is wrong. Food stamps should only be used to buy votes.

A federal indictment unsealed Tuesday charges Jacques Roy, a doctor who owned Medistat Group Associates in DeSoto, Texas, and six others in an alleged scheme to bill Medicare for home health services that were not properly billed, not medically necessary or not done.

The scheme was the largest dollar amount by a single doctor uncovered by a task force on Medicare fraud, authorities said.

As the saying goes, ‘where there is one, there’s a dozen.’ – Or, more likely, a thousand.

U.S. Attorney Sarah Saldana accused Roy of "selling his signature" to home health agencies that rounded up thousands of patients’ names and billed Medicare and Medicaid for five years.

The indictment alleged that from January 2006 through November 2011, Roy or others certified 11,000 Medicare beneficiaries for more than 500 home health service agencies — more patients than any other medical practice in the U.S. More than 75 of those agencies have had their Medicare payments suspended.

More than 75 out of 500? That will show them.

Roy, 54, is charged with several counts of health care fraud and conspiracy to commit health care fraud. He faces up to 100 years in prison if convicted on all counts

Why do we suspect hat will never happen?

Roy had "recruiters" finding people to bill for home health services, said Saldana, the top federal prosecutor in Dallas. Some of those alleged patients, when approached by investigators, were found working on their cars and clearly not in need of home healthcare, she said.

Medicare patients qualify for home health care if they are confined to their homes and need care there, according to the indictment.

Saldana said Roy used the home health agencies as "his soldiers on the ground to go door to door to recruit Medicare beneficiaries."

Oddly enough, if the government does this to buy votes, it is perfectly okay. If these recruiters had been working for the Democrat Party federal government, they would undoubtedly get bonuses for their fine work. But apparently the government resents the competition.

For example, authorities allege Charity Eleda, one of the home health agency owners charged in the scheme, visited a Dallas homeless shelter to recruit homeless beneficiaries staying at the facility, paying recruiters $50 for each person they found

Others indicted are accused of offering free health care and services such as food stamps to anyone who signed up and offered their Medicare number.

Roy would "make home visits to that beneficiary, provide unnecessary medical services and order unnecessary durable medical equipment for that beneficiary," the indictment alleged. "Medistat would then bill Medicare for those visits and services."

The alleged fraud went unnoticed for several years… Until recently, HHS could not effectively track data to identify the kind of fraud now linked to Roy, who was billing beneficiaries "off the charts" for more than five years, officials said. The department’s inspector general, Dan Levinson, told reporters the department’s technology "has not come online as quickly as we’d like to see."

The department is now beefing up its data analysis and tracking other cases, Levinson said. It has also established task forces in several U.S. cities to track Medicare fraud, officials said.

"We’re now able to use those data analytic tools in ways — in 2012 and 2011 — that no, we really could not have done in years past," Levinson said.

Which is what we have been told for about thirty years now. But don’t worry, once we have Obama-Care (which is just Medicaid on steroids) there will be no more fraud.

This article was posted by Steve on Wednesday, February 29th, 2012. Comments are currently closed.

3 Responses to “1 Doc Accused Of Bilking Medicare For $375M”

  1. GetBackJack says:

    Doctors vs. Guns
    The number of physicians in the U.S. in 1995 was roughly 625,000
    The number of deaths induced inadvertently by a physician or surgeon or by medical treatment or diagnostic procedures in the US annually is 784,000
    Resulting estimate of inadvertant deaths per physician per year is 1.25. That means the average doctor will accidentally kill roughly 1.25 people each year.
    The percent of Americans with a gun in their home in 1995 was estimated to be 35%. Of 263 million people in 1995, that makes 92 million with a firearm at home. It is not certain how accurate this figure really is.
    In 1995, the number of total firearm-related deaths was 36,000.
    The number of deaths per person with a gun at home (accidental or otherwise) is then 0.000391. Though just because you live in a house with a gun deos not mean you are its owner.
    As the joke goes, the semi-logical conclusion would be:
    Statistically, “doctors” are approximately 3,000 times more dangerous than “gun owners”.

    Remember, “Guns don’t kill people, doctors do.”
    FACT: Not everyone has a gun, but almost everyone has at least one doctor.

  2. untrainable says:

    So what about the “thousands” of patients who were complicit? The doctor would not have been unable to complete his scheme without willing medicare participants who let their identities to be used to commit the fraud. They just get a pass? Doctor gets 100 years (not) and his willing accomplices just toddle off on their merry way?

    I also find it interesting that medicare frauds apparently all like to work on their cars. Perhaps someone should do a study (government funded of course).

  3. potus4 says:

    This guy should cop a plea, serve a couple years and pay a fine. He has a bright future ahead of him…at ACORN.

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