What is Medicare Fraud?

Medicare fraud occurs when a hospital, nursing home, doctor's office, hospice care facility, ambulance service, pharmacy, rehabilitation center, or any other type of healthcare provider overbills Medicare.


Who can report Medicare fraud?

Medicare fraud whistleblowers are almost always healthcare professionals. They are commonly employed as hospital administrators, nurses, hospice or nursing home workers, ambulance drivers, pharmacists, or as any other type of healthcare professionals.

Receive a financial reward for your information.

Healthcare professionals may be entitled to a significant financial reward for becoming Medicare whistleblowers. Learn about receiving a financial reward for your information here.


Biggest Medicare Fraud Scheme in History Netted $375 Million for Texas Doctor
Print E-mail

Federal prosecutors say a Dallas doctor netted nearly $375 million in the biggest Medicare fraud scheme in history.

Dr. Jacques Roy, 54, was arrested on Feb. 28 on 13 federal charges that could send him to prison for life.

Prosecutors say he recruited thousands of patients, including homeless people, and billed the federal government for medical services that the patients didn't need or that no one ever performed.

The indictment alleges that Roy took advantage of a Medicare rule that a doctor must certify that services for patients are medically necessary. He sold his certification to home health care companies, prosecutors say, and in turn, the companies filed fraudulent charges with Medicare and Medicaid and gave part of the payments to Roy.

As a result of the investigation, 78 companies that worked with Roy's business had their eligibility to receive Medicare funds suspended, and six people were charged as his co-conspirators.

From 2006 to 2011, his company, Medistat Group and Associates, worked with more than 500 Texas home health-care companies to certify over 11,000 patients – more than any other medical practice in the country, according to the indictment. Together, they charged Medicare more than $350 million and Medicaid more than $24 million.

Associates of Roy worked to recruit patients, the indictment states. Sometimes, homeless people were offered money and food to sign up for home health care services.

In one case, court documents say, one associate parked a car outside a homeless shelter and hired people to send potential patients to her. She paid $50 a head for such prospects.

At Medistat Group, the documents state, workers spent all day in a "boiler room" signing Roy's name to documents and churning out claims.

Roy's operation caught the attention of federal investigators years ago, and his Medicare eligibility was suspended in 2011. However, court documents say that he slipped around that suspension by working through other companies he owned and by starting a new business, Medicare HouseCalls.

Prosecutors asked a judge to deny bail to Roy, claiming that he was a flight risk and had planned to take the millions and leave the country.

Bank deposit slips showed he had stashed money in an offshore account in the Cayman Islands, according to court documents. Records also claim that a search of his home last summer turned up a fake birth certificate and driver's license for a Michel Poulin, a Canadian citizenship application, a guide to yacht registration in the Caymans, and books called "Hide Your A$$et$ and Disappear: A Step by Step Guide to Vanishing Without A Trace" and "The Offshore Money Manual."


Report Medicare fraud here.

Help stop government waste and abuse, and get rewarded for your efforts. Our attorneys have significant experience representing healthcare industry whisteblowers. Complete the secure form on this page or call 1-800-581-1790 for a free no obligation consultation with a lawyer.