Maimed

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11941577 - pills and money - business medical background

Many fraud cases cause harm to government programs and taxpayers by stealing funds intended for those who deserve and qualify for the benefits. While that is bad enough, brace yourself for today’s fraudster, who went a couple of steps further, causing the death of two of his victims and leaving another one maimed for life. The man at the center of today’s healthcare fraud case is a Texas physician who is credited with carrying out the largest healthcare fraud scheme in the history of this nation.

Today’s fraudster is a Canadian physician who also holds citizenship in the United States. After earning his medical degree in Quebec and receiving his medical license in Texas, he practiced as an emergency room doctor in the Dallas, Texas area. (Unfortunately, his medical career did not get off to a very good start.) His first casualty was a 6-year-old girl under his care. (After a malpractice suit, her family received a $770,00 insurance payment.)

His next debacle involved a female patient with whom he had an affair. (It turns out her cause of death was contributed to the use of hydrocodone. The doctor had illegally prescribed it to her.) His involvement in the death of his former patient obviously made it difficult for him to get a job. His next job was with a Dallas County jail. As a prison doctor, it wasn’t any time before he wrote a prescription for valium – a narcotic, which was in direct violation of his probation. (He was promptly fired and his medical license was suspended.)

It’s not over yet folks. Surprisingly, the medical board allowed him work for a clinic that treated erectile dysfunction. (Men, cross your legs. This is a painful one.) The very first patient he saw ended up impotent for the rest of his life, not to mention in excruciating pain due to an injection placed in a very sensitive spot. (The man received a six-figure settlement. Let’s hope that brought some closure to the poor guy’s horrible experience.)

The devious doctor’s next venture was home health care. He began a scheme in 2004 where one of his offices caught the attention of federal regulators by submitting the most Medicare claims in the nation for home health services. (You never want to catch the attention of federal regulators.) His practice was credited with performing more home health care visits over five years than any doctor in the United States. (In this case, the devious doctor decided to go big, but unfortunately, he’s not going home, he’s going to jail.)

The physician performed unnecessary home visits and ordered services that were not medically needed. He hired nurses to falsify documents to make it look like his patients qualified for home health care services even though they did not. He also employed people to sign his name on medical documents. (One of the doctor’s co-conspirators paid recruiters $50 to visit homeless shelters and lure patients with free meals.) He also paid people to start health care companies he controlled so that he could obtain more patient referrals to keep his scam running. (His live-in nanny turned down the $5,000 he offered to start a company.)

During a raid of the former Rockwall, Texas physician’s home, agents found a book entitled, Hide You’re A$$ET$ and Disappear, A Step-By-Step Guide to Vanishing Without a Trace as well as other books about hiding money in offshore bank accounts. (Oh, and let’s not forget that he stole someone’s ID and put his picture on it.) The 60-year-old was convicted of 12 counts of health care fraud and obstruction. During his sentencing, which took five hours, the judge handed down a prison term of 35 years. (That ought to suffice. He’ll be 95 when he gets out.)

Out of six co-conspirators, four have already been sentenced to probation or up to 10 years in prison. Restitution amounts for his conniving friends were as low as $397,294 and all the way up to $25 million. (The physician must pay $373,331 in restitution.)

Today’s article explained that while the man admitted what he did was wrong, it took him being in an orange jump suit with shackles around his ankles and waist to grasp the “enormity of the situation.” (A little too late don’t you think?) While he asked for mercy from the judge for his healthcare fraud scheme and didn’t receive it, perhaps now he understands how horrible his crime was against his former patients, honest taxpayers and the government from which he stole.

Today’s “Fraud of the Day” is based on an article entitled, Doctor with history of maiming patients sentenced to 35 years in $373 million home health schemeposted by DallesNews.com on August 9, 2017.

A 6-year-old girl died after being treated by Jacques Roy, but that was only the beginning, a federal prosecutor said Wednesday.

Roy got two patients hooked on prescription drugs so he could have sex with them, one of whom died in a car wreck with high levels of the drug in her system.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.