Federal prosecutors are calling it “the largest home health fraud ever orchestrated by a single doctor.”
And there seems to be a good reason for it.
The Dallas Morning News reports a local doctor accused of recruiting 11,000 fake patients – some of whom were among the ranks of the city’s homeless population – and submitting $375 million worth of false home health care services.
The numbers, if proven in a court of law, are indeed stunning.
In his opening statements, Assistant U.S. Attorney P.J. Meitl told jurors that a doctor cannot possibly care for 11,000 patients.
The doctor’s defense attorney, Robert Scardino, countered with the defense that the doctor made house calls to people who were sick and poor, and that the doctor is being used as a “poster boy” for health care fraud.
So what exactly happened here?
The Scheme
Healthcare fraud cases invariably begins with a what is called a “scheme to defraud.”
In thiscase, prosecutors charge that the defendant, after having his medical license suspended, devised a plan to make as much money as he could and then disappear. They said he and his associates embarked upon a scheme to round up Medicare patients with promises of groceries, food stamps, and money in exchange for non-existent medical treatment. The scheme reportedly included:
- Paying recruiters $50 to walk into homeless shelters and offer free McDonald’s to get “patients.”
- Paying individuals to start health care companies to get more referrals.
- Ordering medical services that were not needed and visited patients unnecessarily.
- Knocking on doors holding a Bible and claiming God wanted the people inside to have health care.
The indictment said hundreds of patient visits were recorded each day by over 500 home health care agencies that routed their patients to Roy. The doctor then billed Medicare and Texas’ Medicaid program for the phony services.
Home health care patients are supposed to be incapable of leaving their house. But when investigators attempted to locate those patients, some were found working on their cars.
Prosecutors said that between the beginning of 2006 and the end of 2011, the defendant’s Medistat office managed more home health care visits than any other single physician in the country.
In 2011, when agents searched Roy’s home, they discovered fake identities and Canadian passport documents along with a book titled Hide You’re A$$ET$ and Disappear, A Step-by-Step Guide to Vanishing Without a Trace.
The prosecution says they have about 70 witnesses to put on the stand, including three of Roy’s cohorts, who pleaded guilty for their part in the scheme, and the defendant’s son, who will explain how he helped Roy hide his crimes.
The Penalties
Since 2012, the defendant has been in federal custody. His bond was denied after the prosecutors provided proof that Roy was planning to flee, revealing a fake identity and offshore accounts.
He has officially been charged with one count of conspiracy to commit health care fraud and 9 counts of substantive health care fraud.
In virtually all instances, healthcare fraud is a felony with a penalty of one year or more in prison that can be accompanied by fines and orders of restitution. The maximum criminal penalty is ten years but increases to 20 years if the fraud scheme results in serious bodily injury.
In addition to the criminal penalties, individuals and entities convicted of a healthcare fraud offense are subject to a civil lawsuit that can result in them being forced to pay two or three times as much as they defrauded in addition to punitive damages incurred by their victims.
The trial is still underway in Dallas. If convicted, he could potentially face life in prison. He lost his medical license. And about $4 million of his assets have been frozen.
Three of the doctor’s associates have already been convicted. They will now testify for the government, as will his own son.
A conviction will assuredly result in severe criminal and civil sanctions.