Dallas doctor convicted in landmark $375 million fraud case, largest ever in home health

Dallas physician Jacques Roy faces decades behind bars and millions in fines after a federal jury convicted him of multiple counts of healthcare fraud, conspiracy, making false statements and obstruction of justice on Wednesday, the Department of Justice announced.

Roy's conviction, along with three home health agency owners, is the culmination of a six-week trial in which the jury deliberated for less than two days before delivering their verdict on the landmark $375 million scheme. The DOJ confirmed this is the biggest home health fraud ever for Medicare and Medicaid.

Roy, 58 of Rockwell, Texas, was convicted of eight counts of healthcare fraud, one count of conspiracy to commit healthcare fraud, and two counts of making a false statement, as well as one count of obstruction of justice.

Cynthia Stiger, 53, of Dallas; Wilbert James Veasey Jr., 64, of Dallas; and Charity Eleda, 55, of Rowlett, Texas were convicted on a variety of charges including healthcare fraud, conspiracy, and making false statements, the DOJ said.

[Also: Texas home health owner sentenced in $375M Medicare fraud scheme]

Each conspiracy and healthcare fraud count carries a maximum 10-year sentence in federal prison and a $250,000 fine. The obstruction of justice count and each false statement count carry a maximum statutory penalty of five years and a $250,000 fine. Roy and his co-conspirators will be sentenced this fall.

According to the DOJ, Roy owned and operated Medistat Group Associates, an association of healthcare providers who provided home health certifications and performed home health visits. Stiger and Veasey owned and operated Apple of Your Eye Healthcare Services, and Eleda owned and operated Charry Home Care Services.

Stiger, Veasey and Eleda, along with others, recruited Medicare beneficiaries to sign up for home healthcare services. Eleda and other nurses falsified medical documents that falsely showed those beneficiaries as qualified for home health services that, in fact, weren't needed. They also falsified documents known as Plans of Care, or 485's, which were given to Roy or another doctor under his direction at Medistat. Roy had his staff certify the unnecessary and falsified documents, that indicated to Medicare and Medicaid that a physician, usually Roy, had reviewed the treatment plans and deemed them medically necessary, and that the patient required home healthcare services.

The DOJ said this process was repeated for thousands of plans of care, and authorities also said Roy had an entire department dedicated to affixing fraudulent signatures and certifications called the "485 Department."

Authorities said after a beneficiary had been certified for home health services, Eleda, nurses who worked for Stiger and Veasey, and others falsified visit notes so that it would appear skilled nursing services were being provided and were still necessary. Roy also visited the patients, performed home visits that were not needed, and ordered unnecessary medical services for the recruited beneficiaries. Medistat employees would submit fraudulent claims to Medicare for the certification and recertification of unnecessary home health care services and other unnecessary medical services under Roy's direction.

[Also: Owners of Texas home healthcare company indicted in Medicare fraud scheme]

Authorities describe Roy's fraud as massive. The DOJ said Medistat processed and approved POCs for 11,000 unique Medicare beneficiaries from more than 500 different home health agencies. They also said Roy entered into fraudulent arrangements with Apple, Charry, Ultimate and other home health agencies to ensure a steady stream of Medicare beneficiaries continued to flow in.

The case was investigated by the FBI, the U.S. Department of Health and Human Services Office of Inspector General, and the Texas Attorney General's Medicaid Fraud Control Unit as part of the Medicare Fraud Strike Force.

Twitter: @BethJSanborn