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In Health Attitude, I described cost as the largest problem in our healthcare system. One of the sources of the high cost I wrote about is fraud. I am often asked where the fraud comes from. I am sure all of us hold our doctors in high regard and would never suspect them of any untoward activities. However, in suburban Dallas, Texas, the FBI got suspicious about a 58-year-old physician. On April 13, a jury in a federal district court  found Jacques Roy, MD guilty of orchestrating a scam that generated $375 million worth of Medicare and Medicaid billings for home health services patients did not need. Prosecutors said Dr. Roy had employees recruit people door to door with offers of groceries, cash, and fast food. He then certified them for unnecessary home health services. The numbers are staggering.

Medscape reported Dr Roy’s practice, called Medistat, fraudulently approved 11,000 Medicare beneficiaries to receive care from some 500 home health agencies between January 2006 and November 2011. Prosecutors said Dr. Roy had a signature factory where employees signed his name thousands of times to process the claims and certifications. A single home care agency, Ultimate Care, during a 5-year period, generated $43 million in billings. More than 75% of the beneficiaries were certified by Dr. Roy’s practice. Law enforcement agents discovered a book at the doctor’s home titled Hide Your Assets and Disappear, A Step-by-Step Guide to Vanishing Without a Trace. Apparently the doctor had plans. It is more likely, after sentencing in the Fall, Dr Roy could spend the rest of his life in prison. See the full story at Physician Convicted in $375 Million ‘Signature’ FraudRead more about healthcare fraud in Health Attitude.

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