The prosecution phase of a huge home health care fraud case came to a conclusion November 28 when the last defendant in the case reported to the Federal Bureau of Prisons to begin serving a 120-month sentence.
The defendant, Cynthia Stiger of Dallas, age 52, also has been ordered to pay $23.6 million in restitution. Her attorney, Scott Miller Anderson of Dallas, said an appeal for her is continuing in the Fifth U.S. Circuit Court.
Read MoreImagine someone parking in a car outside a homeless shelter and recruiting people with Medicare coverage to sign up for home health care services, sometimes paying recruiters $50 for each beneficiary they found. That was one way in which the fraud scheme recruited Medicare beneficiaries in whose names false claims would be filed.
Once beneficiaries were identified, a nurse would falsify medical documents, making it appear that beneficiaries qualified for home health care services that were not necessary. Plans of care (POCs), also known as CMS Form 485s, were delivered to the office of a physician but were not properly reviewed by any physician.
The falsification of documents process was repeated for thousands of POCs in an office know as a “485 Department” that was essentially a “boiler room” to affix fraudulent signatures and certifications on Form 485s, according to the Department of Justice (DOJ).
Once an individual was certified for home health services, a doctor would perform unnecessary home visits, and order unnecessary medical services by others. Then, fraudulent claims were submitted to Medicare, DOJ said.
The government presented evidence at trial that the scope of this operation was massive. Through the scheme, POCs for 11,000 unique Medicare beneficiaries from more than 500 different home health agencies were approved during 2006-2011.
The prosecution of the home care fraud case began with indictments in 2012 and involved hundreds of millions of taxpayer dollars.
Collectively six defendants, including a medical doctor, have been ordered to pay more than $268 million in restitution jointly and severally and serve from 48 to 420 months in prison; one was sentenced to 3 years probation.
U.S. Attorney John Parker of the Northern District of Texas said on October 27: “This office will continue to use the most sophisticated techniques available to aggressively prosecute those, who, through their fraud, drive up the costs of health care to consumers and taxpayers alike.”
DOJ presented at trial evidence that Dr. Jacques Roy of Rockwall, TX, Cynthia Stiger, Wilbert James Veasey, Jr., of Dallas, and Charity Eleda, a registered nurse, of Rowlett. TX, conspired to defraud Medicare and Medicaid through companies they owned or controlled.
This case reminded me of an unrelated one described by an FBI agent at an Association of Government Accountants luncheon in Philadelphia during the 1980s. The agent said a fraud perpetrator obtained buses and would bus residents of senior citizen facilities to a meeting hall where they would play cards or bingo (I can’t recall which). Then the perpetrator would bill Medicare, calling the activity at the hall “therapy,” the agent said.
A DOJ news release about the Dr. Roy case is posted on my website under “Litigation-Related Documents.”
Suspected fraud against Medicaid or Medicare can be reported to the U.S. Department of Health and Human Services’ Office of Inspector General at 1-800-HHS-TIPS (1-800-447-8477) and the agency’s website https://oig.hhs.gov/fraud/report-fraud/.