HHA owner in high-profile Roy case sentenced to a decade in prison.
A year and a half after the feds busted alleged fraudster Dr. Jacques Roy and suspended payments for 78 home health agencies to which he and his practice referred patients, results of the investigation are starting to show.
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 alleg-edly certified or directed the certification of more than 11,000 patients from more than 500 HHAs for home health services during the past 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 em-ployees to complete 485s by either signing his name by hand or by using his electronic signature on the document, prosecutors charge. Medistat and the charged 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.)
Now Ultimate Care co-owner Cyprian Ak-amnonu has been convicted of Medicare fraud in the scheme and was sentenced Sept. 5 to 10 years in prison, according to a new DOJ release. The federal judge also ordered him to pay $25.5 million in restitution. And the judge ordered Akamnonu to forfeit four vehicles, 21 parcels of real estate, and funds in several business and personal bank accounts.
"Akamnonu and Dr. Roy had an agreed-upon, fraudulent arrangement in which Ultimate provided Dr. Roy with [recruited] beneficiaries to bolster Medistat’s patient roster in exchange for Roy’s certification for skilled nursing services of any beneficiary sent to him," the DOJ says. "Nurses would perform cursory visits to the beneficiaries at their homes that bore little relationship to the skilled nursing services for which the beneficiaries had been certified. Then, at Akamnonu’s direction, Ultimate would bill Medicare for skilled nursing services that were not necessary and were never in fact provided."
More than 72 percent of Ultimate’s beneficiaries were certified by Dr. Roy or another Medistat physician, the DOJ says. Ultimate billed more than $40 million to Medicare and Dr. Roy incorporated these patients into his own practice and billed more than $2.3 million for services related to them.
Roy and other co-defendants in the case will face trial in January, the DOJ says.
HHAs See Funds Release, But Remain Confused
In addition to filing criminal charges in the case last February, the Centers for Medicare & Medicaid Services suspended a whopping 78 additional home health agencies associated with Roy based on "credible allegations of fraud against them," the DOJ said at the time. One Texas biller reported suspensions for HHAs that had percentages of Roy patients in the 40s and up (see Eli’s HCW, Vol. XXI, No. 10).
A year-and-a-half later, the suspended agencies are finally being reinstated, multiple billing company owners in the area report. Agencies taken off suspension have received a letter from Zone 4 Zone Program Integrity Contractor Health Integrity notifying them of "reinstatement," one biller relates. HHAs began seeing the reinstatement letters last month.
Local sources have heard of at least nine agencies being taken off suspension. One billing company owner has seen more than a quarter million dollars in back payments disbursed so far.
No comment: Officials with CMS and Med-icare contractors are not releasing any information about the suspensions, including their cessation or how many agencies are still under the hold. That’s because of the ongoing federal investigation against Roy, says one source close to the matter. National and state industry representatives say they have no knowledge of the matter or didn’t respond to requests for comment.
Meanwhile, agencies taken off suspension haven’t received clear information on their current status in Medicare or their options now. They are facing issues ranging from cleaning up auto-canceled RAPs to documentation requirements to Medicaid reimbursement, consultants report.
