Physician Gets 35-Year Sentence for Massive Medicare Fraud

August 16, 2017

If he had pulled off his escape plan, Jacques Roy, MD, might be living in Canada or France now under the alias of Michel Poulin, subsisting off millions in ill-gotten gains, according to federal prosecutors.

Instead, a federal judge in Dallas last week sentenced the 60-year-old physician from Rockwall, Texas, to 35 years in prison for orchestrating a giant home-health scam that generated $375 million worth of Medicare and Medicaid billings, with Medicare representing the most. Dr Roy was ordered to pay a staggering $268 million in restitution.

Dr Jacques Roy (Source: US Marshals Service)

In April 2016, a federal jury found Dr Roy guilty of six counts of healthcare fraud, one count of conspiracy to commit fraud, two counts of making false statements, and one count of obstruction of justice.

Prosecutors said that Dr Roy's practice, called Medistat, fraudulently approved 11,000 Medicare beneficiaries to receive care from roughly 500 home-health agencies. The fraud had many elements:

  • Home-health agencies recruited fake patients — some from a homeless shelter — with groceries, cash, and fast food.

  • A key Medicare form needed to secure payments for home-health services was "falsified, backdated, and churned," prosecutors said. An entire "boiler room" of employees worked all day signing Dr Roy's name on the forms or affixing an electronic one as if he had reviewed the paperwork.

  • Dr Roy and other clinicians affiliated with Medistat made unnecessary home visits and ordered unneeded services such as skilled nursing on the basis of bogus chart notes.

Getting Ready to Leave Town

Police arrested Dr Roy in February 2012, and he's remained in federal custody ever since as a flight risk. One reason why is the alias he created for himself. When police searched his home, they found two different identification cards that featured Dr Roy's photograph and the name of Michel Poulin. Other "Michel Poulin" documents included a Canadian birth certificate and a Canadian passport application. Dr Roy was said to be a fluent French speaker.

Also discovered in Dr Roy's house were books that suggested he was planning to flee. One was titled Hide Your A$$ET$ and Disappear — A Step-by-Step Guide to Vanishing Without a Trace. Two other books explained how to move money offshore. Perhaps not surprisingly, authorities in 2012 confirmed that he had three bank accounts in the Caribbean island of Grand Cayman, one under the "Michel Poulin" alias.

Dr Roy also talked with others about vanishing. One woman testified at his trial that she heard him say he was "leaving and changing his identity."

"Michel Poulin" would have had enough to live on, according to prosecutors. In a court filing after his trial, they said that Dr Roy "conservatively, profited more than $6 million over the course of the conspiracy."

Dr Roy has appealed his conviction and sentence and asked for a new trial. In the motion for a new trial, his attorney said Dr Roy was within his rights to let employees sign Medicare paperwork on his behalf, and that his failure to review some of the forms as required was a civil, not criminal, matter. The attorney also said that prosecutors fabricated a "James Bond narrative" about Dr Roy being a flight risk to make him guilty "in the court of public opinion."

Dr Roy joins five codefendants in the fraud scheme who already have been convicted and sentenced, three of them to 10-year prison terms. A sixth defendant who was convicted last year is scheduled to be sentenced In October.

Follow Robert Lowes on Twitter @LowesRobert

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