Home Health & Hospice Week

Stay tuned to find out the identities of the 78 suspended HHAs.

The entire home care industry is getting painted with the broad fraud brush the feds are using to depict Dr. Jacques Roy and his alleged co-conspirators in the largest home care fraud scam ever busted, and more fraud busts may be on the way.

Recap: The feds have charged Roy and owners from Apple of Your Eye Healthcare Ser-vices Inc., Ultimate Care Home Health Services Inc., and Charry Home Care Services Inc. in the Dallas area with a massive $375 million home care fraud scheme. Payments went back and forth between Roy and the HHAs for patients that didn't really need home care services, alleges an indictment unsealed Feb. 28 (see more details of the charges in Eli's HCW, Vol. XXI, No. 9, p. 68 and in story, p. 76).

Speculation continues to run wild about which home health agencies are among the 78 HHAs associated with Roy facing Medicare payment suspension "based on credible allegations of fraud against them," according to the Department of Justice release. At press time, the Centers for Medicare & Medicaid Services still had not re-leased the names of the suspended agencies, a CMS spokesperson tells Eli.

Expect More Fraud Busts As More Records Are Confiscated

One billing company owner serving the Dallas area tells Eli they've identified about 10 of the 78 suspended HHAs, because they are clients or have called for advice.

Letters dated March 5: Agencies put on suspension in relation to the case received letters from CMS and Zone 4 Zone Program Integrity Contractor Health Integrity dated March 5, the billing company owner explains. The letters tell providers they were put under payment suspension Feb. 28. "Prior notice of the suspension was not provided because the suspension of payment involves credible allegations of fraud," says one suspended agency's letter obtained by Eli. But the payment suspensions started occurring as early as Feb. 27, the billing company found. And some early suspensions were actually take-backs of funds already deposited in the agencies' account. (A CMS rep in Region 6 confirms that the suspensions officially began Feb. 28.) The letters also include the agency's percentage of patients that Roy and other Medistat physicians certified.

One HHA that received a letter also had a visit from the FBI and HHS Office of Inspector General to confiscate records, the biller tells Eli. The CMS rep declined to comment on whether further indictments in this case are expected.

Other agencies with lower percentages have not received visits from the feds -- yet, the biller notes. According to the billing company's internal calculations of percentage of episodes affiliated with Roy and other Medistat physicians, the highest percentage agency that was not placed on payment suspension was 32 percent. (That figure encompasses data only from 2011 on, while the indictment notes data going back to 2006.) The lowest percentage agency that was placed on suspension was 47 percent, according to the biller's calculations and the suspension letters they've seen.

Noteworthy: One billing service provider with many agencies serving Roy's patients notes that the vast majority of the doc's patients are those who have been on service a long time. One of Roy's patients has been on home care service since 2004, for example, the biller says.

Whistleblower Attorneys On The Prowl

The Roy bust has been widely reported in the mainstream press, as have other recent Texas-area home care fraud activities (see items, p. 76 and p. 79). And legitimate providers are bearing the brunt of the reputational burden for the high-profile cases.

"The fraud committed by the very few hurts all of home care and the patients we serve," says the National Association for Home Care & Hospice's Val Halamandaris in the trade group's member newsletter.

Expect scrutiny of the industry to strengthen as a result of this case. That will be in part due to increased interest from lawyers specializing in whistleblower lawsuits, who are trying to entice potential whistleblowers with thoughts of multi-million-dol

lar rewards. "If you have knowledge regarding any health care provider that engaged in fraudulent billing including billing practices at Medistat Group Associates, Apple of Your Eye, Ultimate Care Home Health Services, Charry Home Care Services, or others, you may qualify as a whistleblower under federal law," says the Kendall Law Group in a release aimed at flushing out qui tam relators. "The False Claims Act allows an individual ... to bring a lawsuit on behalf of the United States," says the law firm in Dallas. "Relators stand to receive from 15 percent to 25 percent of any recovered damages. For example, in a recent case, Maxim Healthcare entered into a $150 million settlement and the whistleblower was awarded $15.4 million."

Don't expect the fraud to go away overnight because of one high-profile fraud case, experts say. One HHA serving Roy's patients, but not under suspension, has received calls from other physician groups offering to take on Roy's former patients. "You'd think they'd be running the other way," says the billing company owner informed of this development by the agency.

Indicted Doctor Deemed Flight Risk, Stays In Jail

Meanwhile, a federal judge has refused to release Roy on bail, deeming him a flight risk, according to press reports. When federal agents raided Roy's home in Rockwell, Texas last June, they found a fake ID under another name for the doctor, plus offshore bank accounts in that name. They also found books on how to hide his assets, prosecutors say.

Roy has a long history of patient harm and trouble with the Texas Medical Board, reports the Dallas Morning News.