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Trial Begins for Texas Doctor in $374 Million Medicare Fraud Case

Prosecutors allege Dr. Jacques Roy conspired with home health care agencies in historic scheme

After numerous delays, a trial is under way for the doctor at the center of the largest Medicare and Medicaid fraud case of its kind in history.

From 2006 through 2011, Jacques Roy, then a practicing physician in DeSoto, Texas, allegedly oversaw a fraud scheme that involved about 11,000 Medicare and Medicaid beneficiaries. His co-defendants include three owners of home health care agencies: Charity Eleda, James Veasey and Cynthia Stiger.

Unlike many Medicare fraud schemes, Roy's alleged actions went far beyond recommending unnecessary tests and procedures for existing patients. His network of home health care agencies offered bribes, such as cash, food stamps and groceries, to Medicare patients, many of them from the homeless population of Dallas and surrounding cities. Roy then allegedly used his signature to falsely certify those patients as home-bound and in need of services.

According to prosecutors, Roy's practice brought in so many patients through this recruiting operation that he had multiple employees working full-time to process Form 485 plan of care documents for each new patient. Instead of reviewing each document himself, as required by law, Roy allegedly directed his employees to simply forge his signature.

Several individuals involved in Roy's alleged scheme have already pleaded guilty and are expected to testify against him at trial.

Frustration, jealousy led doctors and home health agencies to participate in fraud

In opening statements, prosecutors described Roy as a frustrated doctor who turned to crime when was unable to achieve success through licit means. Roy's medical license was suspended in 2001 after a woman who had gotten pain pills illegally from him died in a car crash. After the suspension expired, he had difficulty finding steady work.

According to prosecutors, Roy teamed up with similarly frustrated home health care agency owners, planning to make as much money as possible within a short time and then disappear. Because the suspension damaged Roy's reputation in the medical community, prosecutors say he turned to "upstart agencies" on the very fringes of that community.

Roy's alleged actions diverted hundreds of millions of dollars in taxpayers' money away from people who legitimately needed care. It's important to remember that Medicaid fraud is never a victimless crime. While the people involved in this alleged scheme may have profited, they did so at the expense of others.

The trial of Jacques Roy demonstrates just how much is at stake in cases of Medicare and Medicaid fraud - and just how important it is for people with knowledge of that wrongdoing to come forward.