Home Health & Hospice Week

Recruiting patients at a homeless shelter tops list of indicted agencies' alleged misdeeds.

Wondering what your patients, referral sources and payor sources worry you might be up to? Check out the fraud scheme details laid out in the case against Dr. Jacques Roy and three Dallas home health agencies to get a good idea.

Roy and Apple of Your Eye Healthcare Services Inc., Ultimate Care Home Health Servic-es Inc., and Charry Home Care Services Inc. face Medicare fraud charges in a purported $375 million scheme (see related story, p. 74). Here's how the feds say the fraud went down with each agency:

• Apple. In January 2006, Roy entered into a "secret agreement" with Apple owners Cynthia Stiger and Wilbert James Veasey Jr. to pay all of Apple's operating expenses in return for 50 percent of the agency's profits from billing Medicare home care services, the feds allege in an indictment unsealed Feb. 28. Eighty percent of Apple's patients from 2006 to 2011 were certified by Roy or another physician in his practice, Medistat Group Associates.

• Ultimate. Roy certified patients for Ultimate, owned by RN Patricia Akamnonu and Cyprian Akamnonu, in return for cash kickbacks paid to his office manager Terry Sivils, the feds allege in the indictment. Patricia recruited beneficiaries for Ultimate by offering free health care and free services such as food stamps. Sometimes Ultimate signed them up for home care without their knowledge, prosecutors say. Seventy-eight percent of Ultimate's patients from 2006 to 2011 were certified by Roy or another Medistat physician.

• Charry. Owner Charity Eleda, an RN, recruited homeless patients at The Bridge shelter in Dallas and paid them $50 a piece, the indictment charges. Roy "examined" the patients at the shelter or outside of it. When the shelter got wind of the practice and would not allow Eleda to visit the patients, she started seeing them at a nearby church, prosecutors say. From 2008 to 2011, 79 percent of Charry's patients were certified by Roy or another Medistat doc.

In a release, the Bridge explained its role in the investigation. "In 2010, we became aware of suspicious activities involving the medical care of our guests unrelated to the on-site health care services we provide," Jay Dunn, CEO of The Bridge, said in a statement. "As a result, our services team collaborated with local authorities to investigate and respond," Dunn said, according to the Dallas Obser-ver newspaper.

Clinicians at all three agencies would falsify OASIS assessments to make non-homebound patients appear homebound, the prosecutors charge. They also would write visit notes for visits that never occurred.

The HHA fraud is in addition to the fraud alleged at Medistat itself, which ran a "485 Department" dedicated to churning out bogus certifications and plans of care. "Medistat received hundreds of POCs and/or requests for physician orders ... per day from HHAs," the indictment says. Roy and Medistat also billed for unnecessary physician home visits to patients and unnecessary durable medical equipment for them, the indictment adds.