Blog | Thursday, April 12, 2012

Breathtaking Medicare fraud alleged


This week the Medicare empire of Dr. Jacques Roy of Texas came crashing down.

Dr. Roy and his business partners have been accused by federal investigators of fraudulently billing Medicare (i.e. you and me) $350 million.

That's a lot of Band-Aids, no matter how expensive they are.

The bills were run up in a mere six years. Rounding up a tad, that averages out to $60 million per year, or $5 million dollars a month of Medicare billing.

The allegations include falsely enrolling seniors for home health services they neither requested, were eligible for, or ever received. It seems the doctor and his associates simply found people with names and ages, and issued bills for services in their names.

Dr. Roy's company, Medistat, with only six doctors on staff, supposedly provided service to more than 11,000 Medicare patients. This made Medistat the largest single Medicare home health provider in the country.

You'd think this would be an instance where blending in would've been a better criminal strategy.

Outliers, beware.

No comments on why it took five years to bring the charges. Better late than never.

Does it mean anything that Dr. Roy is Canadian? Clearly he saw more economic opportunity in our wild-West, free-market medical system than he did back home where things are a bit more controlled.

This post by John H. Schumann, MD, FACP, originally appeared at GlassHospital. Dr. Schumann is a general internist. His blog, GlassHospital, seeks to bring transparency to medical practice and to improve the patient experience.