NAHC responds to massive health care fraud case in Texas

The National Association for Home Care & Hospice (NAHC) last week called for better, more comprehensive integrity programs after government officials announced one of largest cases of health care fraud in the nation’s history.

NAHC’s statement came after officials from the U.S. Justice Department and the Department of Health and Human Services announced on Feb. 28 allegations that a Texas doctor had fraudulently certified more Medicare beneficiaries for home health care services than any other physician in the nation.

Dr. Jacque Roy, owner of Medistat Group Associates of DeSoto, Texas, and five owners of home health care companies were accused of billing Medicare and Medicaid for unnecessary or poorly provided home health services totaling $375 million from January 2006 through November 2011. The defendants were accused of finding patients by paying home health agency recruiters to canvass a Dallas shelter for the homeless. The recruiters offered the patients free health care or food stamps in exchange for their Medicare numbers.

The announcement immediately raised questions about how such a massive fraud could remain undetected for so long. Medicare said the activity was revealed by new tools that analyze billing data and find patterns of potential fraud.

NAHC congratulated officials for taking action to stop the alleged fraud, but noted that for years it has pushed for stronger programs to protect the integrity of government health programs.

“NAHC has advocated for comprehensive integrity programs, such as screening home health agencies that seek to participate in the Medicare program, evaluating the background of those who own or manage home health agencies and strengthening physician involvement in planning and delivery of home health care,’’ a NAHC statement said. “The end result of all this should be to improve the fiscal integrity of government programs.”