Home Health & Hospice Week

Six-week trial produces three HHA owner convictions.

The federal prosecution of the largest home health fraud scheme to date has concluded with a fraud conviction and a potential 100-year prison sentence for the physician mastermind.

Reminder: Physician Jacques Roy owned and operated Medistat Group Associates in the Dallas area. Medistat was an association of health care providers that primarily provided home health certifications and performed patient home visits, the Department of Justice said in a February 2012 release. Dr. Roy allegedly certified or directed the home health certification of more than 11,000 patients from more than 500 HHAs over five years, the DOJ said. Many of those were for medically unnecessary services and services never provided as part of a massive $375 million fraud scheme. Dr. Roy allegedly instructed Medistat employees to complete 485s by either signing his name by hand or by using his electronic signature on the document, prosecutors charged. Medistat and the HHAs — Apple of Your Eye Healthcare Services Inc., Ultimate Care Home Health Ser vices Inc. and Charry Home Care Services Inc. — used patient recruiters for the scheme. (See Eli’s HCW, Vol. XXI, No. 9 for more details of the case.)

Two HHA owners in the case already pled guilty. Ultimate co-owners and husband and wife Cyprian Akamnonu and Patricia Akamnonu entered their pleas in 2012 and 2015, respectively, and received 10 years each in federal prison as well as an order to pay $25 million in restitution. And Medistat office manager Terri Sivils pled guilty a year ago and is awaiting sentencing in June, the Department of Justice notes in a release.

In the six-week trial that began March 9, three more HHA owners were found guilty: Apple co-owners Cynthia Stiger and Wilbert James Veasey Jr., and RN and Charry owner Charity Eleda. Eleda improperly recruited patients from a homeless shelter and forged documentation for them, the DOJ showed.

But the big fish was Roy himself, who has been in federal custody since his arrest in February 2012. He was denied bail after investigators found false identification papers at his home and identified offshore bank accounts.

The federal jury convicted Roy on multiple fraud counts, as well as making a false statement and obstruction of justice, the DOJ notes. Altogether, the maximum sentence for the convictions could add up to 100 years. Roy and the other defendants face sentencing this fall.

Data Outlier Status Pointed Way To Fraud

It wasn’t just Roy and the HHA owners who were punished in this case. In conjunction with their indictments announced in 2012, Medicare suspended payments for 78 HHAs that had a large percentage of referrals from Roy and Medistat physicians (see Eli’s HCW, Vol. XXI, No. 9).

Lesson learned: The case showed that agencies who fail to diversify their referral sources are at risk of fraud suspicions. A billing analysis showed some agencies that had a relatively low percentage of their patients from Roy and Medistat were swept up in the suspensions.

About a year after the suspensions were imposed, Medicare began lifting them for a handful of providers (see Eli’s HCW, Vol. XXII, No. 32). But the damage had already been done for the vast majority of agencies, who were forced to close their doors, local sources tell Eli.

The feds are still using suspension authority today, although not in such a widespread and public manner as in the Roy case.

For example: “I have seen three cases since the beginning of the year where CMS has imposed a payment suspension as a result of an overpayment identified by a [Zone Program Integrity Contractor] audit,” notes attorney Robert Markette Jr. With Hall Render in Indianapolis. “In talking with the ZPIC, they stated CMS has indicated that suspensions should be imposed in overpayments to avoid further pay-and-chase efforts.”

Data mining showing Roy’s extreme outlier status for home health certifications helped propel this case. “This office will continue to use the most sophisticated techniques available to aggressively prosecute those who, through their fraud, drive up the costs of health care to consumers and tax payers alike,” said U.S. Attorney John Parker of the Northern District of Texas in the release.