It’s one thing to sneak a few hundred — or even a few thousand — dollars under the federal government’s radar. But how in the world did a Texas doctor allegedly manage to bilk the feds out of almost $375 million in bogus Medicare claims in only five years?
According to reports, the Dallas-based doc hired recruiters who would go door-to-door convincing people to sign documents claiming they had received an in-home visit from the doctor.
The recruiters were also paid, upwards of $50 a person, to go to homeless shelters, where they would then take people to nearby parking lots to sign the forms.
Feds have also charged the owners of three home health agencies for their parts in the scheme, and suspended payments of around $2.3 million a month to 78 additional agencies in the Lone Star State.
It wasn’t until 2010 that the Dept. of Health & Human Services’ computers caught on that their might be a problem. That was when HHS analysts noticed that the Texas doctor had signed off on more than 5,000 home health patients, where as 99% of doctors have a maximum of around 104 patients.
“To get that kind of money, you’d need to be treating a million people,” one lawyer tells the L.A. Times about just how obvious this scheme should have been to HHS. “You’d have to have 30 locations and tons of people going through them.”
The doctor now faces up to 100 years in prison and at least $18.5 million in fines and forfeitures.
Doctor charged in nation’s largest healthcare fraud scam [L.A. Times]
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“The doctor now faces up to 100 years in prison and at least $18.5 million in fines and forfeitures.”
Bilk government system for $375 Million dollars… only pay $18.5 of it back?
My first thought as well. Fines that are issued as punishments for theft of any sort should, at the very least, equal ALL profit made from the scheme.
Fines are usually separate from reparations — that is the fines are a set criminal punishment, while the reparations are paying back money that was ill-gotten.
Ah, so it’s more like he had to pay 18.5 million on top of the money he illegally acquired.
This makes me feel better, and makes much more sense, if indeed that’s how it works. :C
They probably only paid out $18.5M.
He filed 375 mil in claims. Had medicare paid all those claims they probably would have paid about 30 to 40% of the claims has the allowed amount is generally 35 to 40% of the billed amount (For most providers). Less deductible and copays, so I’m guessing he must have got about 120 Million. Still a lot of fraud to warrant only a 18.5 mil fine.
Considering the average primary care physician probably only bills out about 300k to 500K a year a year it seams someone should have caught it.
I’m applying to med school right now; i figure that i can be in and out and rich in six months (the investigation takes twice as long) safely.
Only $18.5 Million in fines and forfeitures? Unless I am reading that wrong, does that mean he gets to keep about $300 Million? If so, that is crazy talk.
He sure does. That’s a lot of Snapple… from the prison commissary.
Looks like TX trying to knock off Florida as the top Medicare ripper off er.
Ya, and California & Illinois are both p^ssed that they can’t seem to take the no. 1 spot.
You’ve left out an important part of the story. This Medicare scammer masquerading as a doctor has been one of the core financial backers of the Tea Party.
Maybe because this site deals primarily with Consumer issues, and not political grandstanding?
Does it now? Could have fooled me!
He has? Daily Kos and OpenSecrets.org has his donations at $1,650. You consider that a core financial backer? That’s from 2008 on, mind you.
http://www.dailykos.com/story/2012/02/28/1069138/-TBagger-Doctor-Indicted-In-Largest-Medicare-Fraud-In-History
http://www.opensecrets.org/indivs/search.php?name=roy%2C+Jacques+&state=TX&zip=&employ=&cand=&c2012=Y&c2010=Y&c2008=Y&sort=N&capcode=r92j8&submit=Submit+your+Donor+Query
The man is practically the Norman Hsu of the Tea Party!
I love the Kos article that makes it seem like he is a huge donor and the responses. Do they search open secrets for every person that donated any money just to lump them in and fire up morons?
Guess it worked on Mr. Butz. It’s kinda like those idiots you see when any black person commits a crime and make the, “must be an Obama supporter” comment. But those are in the comments section and this is on a blog. Kinda sad.
I think it’s funny that a guy who repeatedly donates money to the Tea Party had no problem bilking money out of one of those evil socialist entitlement schemes, but in the context of the entire story, that detail really isn’t as important as you think it is.
Looks like he should have put some of that money towards lobbyists and campaign contributions.
Doesn’t surprise me. The whole medical industry is full of corruption and greed.
I’m STILL fighting a hospital over an item on my bill. Pap-smear supposedly performed while I was in for a bout of pneumonia. Considering I’m male, I find it highly unlikely they actually did one.
That’s not a second anus…
I’m guessing they did something like a Gram-positive bacterial smear, mistyped and miscoded it at the time, and now either are barred from adding a new charge as an “anti-fraud” measure, or adding a new procedure at this point will trigger the kind of audit that will require a rubber glove and some lube. So they’re hoping to wear you down rather than eat the cost of the procedure.
(Either that, or it’s just complete bullshit, and their billing department has been told to never take no for an answer or you’re fired.)
That would be funny if it wasn’t so infuriatingly stupid.
The Bernie Madoff of Medicare fraud…
When the scale of deceit and crime is this large, hanging should be required.
Ssss… Poor form, Ned. Poor form.
Are you a REAL Doctor, Dr. Ned?
Of course I am! Don’t you see the ‘Dr.’ in front of my name?
I spend most of my day doctoring!
I’m confused on why he only owes 18.5 million? Now with life in prison, he’d still be living off ill-gotten government means.
This sort of thing happens all of the time. My wife worked for a dentist that would bill insurance companies for services not rendered.
This is just one case. How many others are out there, doing the same thing? $375 Million here, there, and over there soon adds up to real money in government terms, who are dealing with deficits in the trillions of dollars.
This is pretty much what is happening on Justified.
*shocked*
Texans were told that it was frivolous lawsuits that were the cause of high health care costs. So, they passed the reform legislation. Less than a year later, many of us saw rate hikes of 50% or more.
Now, we know the real cause.
More proof that we do everything bigger in Texas, even our fraud.
And who gets blamed for the Medicare “crisis” and fraud? Those of us who wouldn’t have insurance at all without it.
I bet this is related to all these “SEND US YOUR PERSONAL INFORMATION SO WE CAN MAKE MEDICARE CLAIMS ON YOUR BEHALF” offers in relation to catheters/hoverounds,diabeetus supplies.