DALLAS—Physician Dr. Jacques Roy was charged in what federal authorities describe as a $374 million conspiracy to defraud Medicare and Medicaid through a vast patient-recruiting and false-billing effort for home-healthcare services.
Regional News/South: Physician charged in $374 million fraud conspiracy, and other news
If convicted, he could face a life sentence in prison, according to a memorandum to detain Roy. Federal authorities called the takedown of Roy and six co-conspirator suspects the largest Medicare fraud orchestrated by one doctor in U.S. history. Roy, 54, of Rockwall, Texas, was charged with nine counts of conspiring and one count of carrying out healthcare fraud. Investigators said that since 2006, Roy has taken more than $18.5 million, with millions of that hidden in “various accounts and investments.” Roy was charged with certifying more than 11,000 patients around Dallas for home-healthcare services they did not need. Such certifications allowed Roy's former company, Medistat Group Associates, along with more than 500 independent home-healthcare agencies, to submit claims for Medicare and Medicaid services for those beneficiaries. According to the indictment, Roy certified more patients for home-healthcare services than any other provider in America. Together, Medistat and the independent agencies billed government healthcare programs for more than $374 million between June 2006 and November 2011.
MIAMI—UnitedHealthcare, part of UnitedHealth Group, Minnetonka, Minn., has agreed to buy two Florida health plans with about 97,000 members and eight care centers between them. Terms were undisclosed. Under the agreement, UnitedHealthcare will buy Preferred Care Partners, Miami, which has about 50,000 Medicare Advantage members in South and Central Florida and in the Tampa area, according to a UnitedHealthcare news release. Preferred Care began serving Medicaid beneficiaries last year through its CareFlorida plan, which has about 5,000 members. Preferred Care also has six primary-care centers in Miami-Dade and Broward counties that are a part of the deal. In a separate transaction, UnitedHealthcare agreed to buy Medica HealthCare Plans, Coral Gables, Fla., which has about 35,000 Medicare Advantage members and 7,200 Medicaid beneficiaries in Miami-Dade and Broward counties. Medica also operates two medical centers, according to the release. The transactions are subject to customary regulatory approvals and are expected to close this year.
MIAMI—Jackson Health System President and CEO Carlos Migoya announced a plan to cut 1,115 jobs and make other changes to save $91 million a year in personnel costs as the large public hospital system struggles to realign its cost structure. “These actions will be painful for many people, including those whose positions are eliminated and those who will be working even harder to care for this great system and its patients,” Migoya wrote in a Feb. 28 letter to the Financial Recovery Board of the Public Health Trust, which governs the 2,186-bed hospital system. Martha Baker, president of the system's largest union, SEIU Local 1991, blasted the announcement as “what you get when you hire a billionaire banker and then cut him loose to take a chain saw to healthcare.” Migoya, hired last April, wrote in the letter that 920 active staff members' jobs will be cut, along with 195 vacant positions, based on “department-by-department reviews designed to properly align our workforce to our patient volumes and business plan.” The cuts—about 10% of the workforce, including 187 job reductions from 2011—will go into effect by the end of April, according to the letter. The system will hire 350 part-time employees with benefits, whose costs are included in the estimated savings. Financial disclosures to Jackson Health bondholders say the system posted a $93 million net loss in fiscal 2010, following a $245 million loss the year before, the most recent figures available.
HOUSTON—A former hospital assistant administrator pleaded guilty to a kickback scheme in which he paid patient recruiters to send Medicare beneficiaries to the hospital's partial hospitalization programs. Mohammad Khan, who controlled the operations of the partial hospitalization programs for 89-bed Riverside General Hospital, admitted in the plea agreement that he and unnamed conspirators billed Medicare for $116 million for services that were either unnecessary or not performed. In addition to paying recruiters and owners of group homes and assisted-living facilities for the flow of patients, Khan rewarded Medicare beneficiaries with cigarettes, food and coupons redeemable at the hospital's stores. The scheme, according to the agreement, occurred from January 2008 through Feb. 8, the day Khan was arrested. A hospital representative said that Khan has been terminated and that neither the hospital nor any other hospital employee has been charged in connection with the scheme. According to a statement, Riverside General “is committed to compliance and guarding against fraud, waste and abuse in the Medicare program” and “is cooperating fully with the government's investigation.” Khan pleaded guilty to one count of conspiracy to commit healthcare fraud, one count of conspiracy to defraud the U.S. and five counts of healthcare kickbacks.
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