Physician Gets 35-Year Sentence for Massive Medicare Fraud

Physician Gets 35-Year Sentence for Massive Medicare Fraud

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If he had pulled off his escape plan, Jacques Roy, MD, might be living in Canada or France now under the alias of Michel Poulin, subsisting off millions in ill-gotten gains, according to federal prosecutors.

Instead, a federal judge in Dallas last week sentenced the 60-year-old physician from Rockwall, Texas, to 35 years in prison for orchestrating a giant home-health scam that generated $375 million worth of Medicare and Medicaid billings, with Medicare representing the most. Dr Roy was ordered to pay a staggering $268 million in restitution.

Dr Jacques Roy (Source: US Marshals Service)
In April 2016, a federal jury found Dr Roy guilty of six counts of healthcare fraud, one count of conspiracy to commit fraud, two counts of making false statements, and one count of obstruction of justice.
Prosecutors said that Dr Roy's practice, called Medistat, fraudulently approved 11,000 Medicare beneficiaries to receive care from roughly 500 home-health agencies. The fraud had many elements:

Home-health agencies recruited fake patients — some from a homeless shelter — with groceries, cash, and fast food.

A key Medicare form needed to secure payments for home-health services was "falsified, backdated, and churned," prosecutors said. An entire "boiler room" of employees worked all day signing Dr Roy's name on the forms or affixing an electronic one as if he had reviewed the paperwork.

Dr Roy and other clinicians affiliated with Medistat made unnecessary home visits and ordered unneeded services such as skilled nursing on the basis of bogus chart notes.