Whistleblower Reveals $375 Medicare Fraud Scheme

Medicaid and Medicare fraud is a serious drain on public funds, and it can also threaten patient safety. A whistleblower was motivated by concern for patient safety when she reported to authorities last year that her employer and a local doctor were filing false claims with the Medicare program. Dr. Jacques Roy, owner of Medistat Group Associates in DeSoto, Texas, masterminded a $375 million Medicare fraud scheme involving home health services. According to WFAA, the alleged fraud went on for five years or more.

Dr. Roy recruited home health agencies to bill Medicare for home health services that were unnecessary or not actually provided. Allegedly, equipment sometimes was not picked up even after Medicare had paid for it, and some patients suffered from not having the services they needed. The whistleblower said that she believed at least one patient died without access to needed equipment. Sometimes, the conspirators continued to bill Medicare for treatment months after a patient had died.

The whistleblower worked with two co-workers to gather evidence of the false claims. No government action was taken against this high-dollar Medicare fraud until the whistleblowers came forward. At the behest of the Federal Bureau of Investigation (FBI), they then spent months wearing hidden microphones at work to record conversations related to the fraud.

The government relies on whistleblowers to report evidence of false claims against the government. Inside information from employees or others close to the fraud often provide the only, and certainly the fastest and most efficient, way to uncover such evidence. Because their participation is so important, the qui tam provision of the False Claims Act allows individuals with knowledge of fraud to file a lawsuit on behalf of the government and share in the final recovery.

Waters & Kraus is a national firm with highly skilled lawyers practicing qui tam litigation in four offices, including Dallas, Los Angeles, San Francisco, and Baltimore. Our attorneys have decades of experience successfully representing whistleblowers in a variety of fraud cases. Contact us or call our attorneys at 800.226.9880 to learn more about our practice and how we can assist.

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