Arrests made in ‘largest ever’ home health fraud scheme

A Dallas-based physician and five owners of home health agencies were arrested Tuesday on charges for their alleged participation in a scheme to defraud Medicare and Medicaid by nearly $375 million.

The arrests and charges were announced by several government agencies, including the Department of Health and Human Services (HHS), the Justice Department and the FBI.

The indictment alleges that Dr. Jacques Roy, MD, 54, of Rockwall, Texas, owned and operated Medistat Group Associates P.A., and 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.

Between January 2006 and November 2011, Medistat certified more Medicare beneficiaries for home health services and had more purported patients than any other medical practice in the United States, HHS said. Roy allegedly used the home health agencies as “recruiters” in the fraud scheme, according to the indictment.

The 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 the home health agencies.

Assistant Attorney General Lanny A. Breuer of the Justice Department called it the “largest alleged home health fraud scheme ever committed.”

“Fraud schemes, like the one we allege Dr. Roy executed, represent the next wave of Medicare and Medicaid crime that we face,” said U.S. Attorney Sarah R. Saldaña of the Northern District of Texas.

In addition to Roy, the indictment, filed in the Northern District of Texas, charges 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 with one count of conspiracy to commit healthcare fraud. Roy is also charged with nine counts of substantive healthcare fraud.

The Centers for Medicare & Medicaid Services also announced the suspension of an additional 78 home health agencies associated with Roy based on credible allegations of fraud against them.

The federal government attributes the arrest to Medicare Fraud Strike Force operations, which are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT). HEAT is a joint initiative announced in May 2009 between the Department of Justice and HHS to prevent and deter fraud and enforce anti-fraud laws around the country.

HHS recently announced that the government had recovered nearly $4.1 billion in healthcare fraud cases during FY2011—the highest annual amount ever recovered.

“Using sophisticated data analysis we can now target suspicious billing spikes,” said HHS Inspector General Daniel R. Levinson. “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.”

Three of the home health agencies Roy allegedly used as part of the scheme were Apple of Your Eye Healthcare Services Inc., owned and operated by Stiger and Veasey; Ultimate Care Home Health Services Inc., owned and operated by Cyprian and Patricia Akamnonu; and Charry Home Care Services Inc., owned and operated by Eleda.

According to the indictment, Veasey, Akamnonu, Eleda and others recruited beneficiaries to be placed at their agencies so that they could bill Medicare for the unnecessary services or services not provided.

Eleda also allegedly visited The Bridge Homeless Shelter in Dallas to recruit homeless beneficiaries staying at the facility, paying recruiters $50 per beneficiary they found at the shelter and directed to Eleda’s vehicle parked outside the shelter’s gates.

Each charged count of conspiracy to commit healthcare fraud and substantive healthcare 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 numerous items including funds in bank accounts, a sailboat, vehicles and multiple pieces of property.

Topics: Medicare/Medicaid