Sham Doctor Networks Make Billions in Texas
Question: When did the federal government help pay for someone’s $13 million palatial estate, complete with a backyard water park, along with the owner’s private G-7 jet?
Answer: When its healthcare bureaucracy mistakenly gave money to a dentist charged with extensive Medicaid fraud.
Consider the case of a former owner of a chain of clinics throughout Texas. According to federal auditors, for five years his clinics sent vans into impoverished neighborhoods to recruit children and induce their parents to bring them to his clinics. Small gifts to children and parents were sometimes involved.
According to federal fraud charges, rudimentary – many times unnecessary – cosmetic dental work was performed on these children. Then the clinics massively overbilled Medicaid for his services. And when federal auditors and investigators started closing in on the scam, the owner quickly sold his clinics. Since then, what’s left of the clinic chain has changed ownership more than once.
Even after the owner settled the first federal fraud charge shortly after selling the business, the current owners of the largely defunct company continued to negotiate unresolved federal Medicaid fraud charges. They most recently paid an $8 million dollar settlement in 2017. The original owner, on the other hand, remains free, though he has moved on from being a healthcare provider.
We routinely read or hear news about others perpetrating healthcare scams on the public involving Medicare or Medicaid. And though the “official numbers” as to the depth of the problem are hard to get from the government, a recent story by National Public Radio (NPR) estimated that annual healthcare fraud losses are in the range of $60 billion, and likely much higher. The latest on a growing list of unmasked Texas healthcare scammers include:
- The owner of a string of Houston home healthcare clinics was sentenced to 40 years in federal prison in August 2017 for a brazen scheme involving several workers who bilked more than $17 million in fraudulent Medicaid and Medicare billing that stretched from the Gulf Coast to North Texas and west to the Hill Country.
- The operators of a Dallas healthcare practice was arrested and charged in May 2018 with distributing physician orders and certifications to over 100 home health agencies, allowing them to charge Medicare about $2.5 million in false billings, according to a whistleblower.
- A North Texas federal court in early July 2018 convicted a 70-year-old semi-retired Texas emergency room physician who, with two private nurses, was found guilty of signing Medicaid paperwork which enabled the illegal distribution of opioids. He was convicted on four fraud charges for his role in a $13 million home healthcare scam. His role was what prosecutors called his “rubber stamp signature” on fraudulent documents. The jury also found the doctor’s co-defendants – a pair of home healthcare nurses – guilty of healthcare fraud.
One of the largest contemporary fraud cases – at least here in Texas – involved former Rockwall physician Jacques Roy, who in 2017 was sentenced to 35 years in prison by a North Texas federal court. He was also ordered to pay $268 million in restitution.
From 2003-2011, Roy and others were reported to have courted about 11,000 Medicare patients with promises of cash and groceries. They took $373 million from Medicare and Medicaid with their home healthcare scheme, using fake patients – including some of Dallas’s homeless. When it occurred, it was the largest home health fraud ever masterminded by a single doctor, according to the Dallas Morning News.
So, when you experience the rising cost of healthcare, be it public or private, now you know some of the stories of a few of the scammers, since in the end, those losses are paid by all of us.