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Alleged Health Care Fraud Totaling Almost $375 Million

Health care fraud scheme results in arrests of Dallas-area doctor, office manager, and five home health agency owners

Seven people have been arrested — including a doctor, his office manager, and five home health agency owners — for an alleged health care fraud scheme involving almost $375 million in false claims against Medicare and Medicaid programs. The indictment alleges that Dr. Jacques Roy of Rockwall; Cynthia Stiger and Wilbert James Veasey Jr., of Dallas; Cyprian Akamnonuof and Patricia Akamnonu, RN of Cedar Hill; Teri Sivils of Midlothian; and Charity Eleda, RN of Rowlett were involved in conspiracy to commit health care fraud by making fraudulent charges for home health services. Dr. Roy, Mr. Veasey, Ms. Akamnonu, and Ms. Eleda are also charged with additional counts of health care fraud. Ms. Eleda is also accused of making false statements concerning a Medicare claim.

The indictment alleges that Dr. Roy’s company, Medistat Group Associates P.A., performed patient home visits and provided home health certifications. Allegedly, over the past five years, Dr. Roy personally certified or directed others to certify over 11,000 patients from over 500 home health agencies for home health services. Because they documented services that were not medically necessary and/or were not actually performed, these certifications for home health services allegedly cost Medicare $350 million in fraudulent claims and cost Medicaid over $24 million in fraudulent claims by both Medistat itself and the home health agencies.

The consequences of health care fraud can be severe. Each count of conspiracy to commit health care fraud and of substantive health care fraud, if proven, can result in a sentence of up to 10 years in prison and a fine of $250,000. Each charge of making false statements, if proven, carries with it a possible sentence of up to five years in prison and a fine of $250,000. Forfeiture of the fruits of this fraud is also a possible consequence. Of course, at this stage, the defendants have only been accused of wrongdoing. They are presumed innocent unless and until the charges are proven in court.

The alleged fraud has far-reaching consequences, moreover. In addition to the charges brought against these seven individuals, the Center for Medicare and Medicaid Services has announced that an additional 78 home health agencies that have connections to Dr. Roy will be suspended because of credible allegations of health care fraud against them.

This enforcement action was spearheaded by the Medicare Fraud Strike Force, a unit of the Health Care Fraud Prevention & Enforcement Action Team (HEAT). This joint initiative of the Department of Justice (DOJ) and Health and Human Services (HHS) works to prevent fraud and enforce anti-fraud laws across the nation. This case represents the largest health care fraud scheme organized by a single doctor that HEAT has investigated since it was established in 2009. In this case, the investigation required the cooperation and involvement of a number of governmental agencies, including the DOJ, HHS, the Federal Bureau of Investigation (FBI), the Centers for Medicare and Medicaid Services (CMS); and the Texas Medicaid Fraud Control Unit (MFCU).

Medicare and Medicaid fraud costs the government, and thus costs taxpayers, billions of dollars. This case alone is alleged to have involved nearly $375 million. Initiatives like HEAT are making a tremendous difference in enforcing anti-fraud laws. But often, the best and sometimes the only way to get accurate information about ongoing health care fraud is from a whistleblower — someone with personal knowledge of the fraud who is willing to come forward to stop it.

Because it is so important to have whistleblowers share what they know about health care fraud, the law offers them protections, enables them to file a lawsuit on behalf of the government, and provides them a share in any recovery.

Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Los Angeles, San Francisco, Dallas and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in health care fraud cases. Contact us or call our attorneys at 800.226.980 to learn more about our practice and how we can assist.

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