Whistle-blower speaks out in Medicare fraud case

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by REBECCA LOPEZ

Bio | Email | Follow: @rlopezwfaa

WFAA

Posted on February 28, 2012 at 11:06 PM

Updated Wednesday, Feb 29 at 8:48 AM

NEWS 8 EXCLUSIVE

News 8 is talking to the whistle-blower in a $375 million Medicare fraud case.

Investigators said Dr. Jacques Roy of DeSoto was the mastermind at the top of the criminal pyramid.

He allegedly used home health agencies to approve claims for services that were neither needed nor delivered.

A year ago, the whistle-blower — who asked that we not identify her — went to authorities because she was concerned about patient safety.

"I had come across a case where a patient had passed away because they were on the wrong equipment than we were billing medicare for," she said.

The woman worked for a home health agency, and noticed something was wrong when she went to the office of Dr. Jacques Roy. She said Roy and her employer were fraudulently billing Medicare for home health care.

In some cases, the patients had passed away.

"They wouldn't go pick up the equipment and continue to bill for three to six months after they were deceased," the woman said. "A lot of patients, we don't know... upon further investigation by my colleagues and I, couldn't find any proof they were legit patients."

The U.S. Attorney's office alleges that Dr. Roy, owner of Medistat Group Associates, would sometimes recruit people from homeless shelters to bill for home health care that wasn't needed.

The Office of Inspector General said they were the ones who noticed the suspicious billing practices by using high tech data analysis.

"Our special agents and analysts spotted the trend and swung into action," Inspector General Daniel Levinson said.

But our whistle-blower said she and two of her co-workers were the ones who gathered the evidence. She said the FBI had them turn over their computers, wire-tapped their cell phones and had them wear hidden microphones.

"Myself and two colleagues really felt strongly about this, and we spent months being miked up and had our lives on the line," the whistle-blower said. "We were fearful."

The fraud went on for at least five years. It's believed Dr. Roy and his associated bilked the government out of $375 million, and it wasn't until the whistle-blower came forward that the government took action.

The whistle-blower said she believes other patients were harmed because they didn't get the proper equipment they needed and were billed for it.

The Department of Health and Human Services says up until recently, it couldn't effectively track data that would uncover Medicare and Medicaid fraud. But it is now a priority, and they say they are better equipped to investigate.

E-mail rlopez@wfaa.com

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