Health Integrity Team Included in Office of Inspector General’s Cooperative Achievement Award

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The Department of Health and Human Services Office of the Inspector General presented the Cooperative Achievement Award to a team including several Health Integrity staff.  The award was “in recognition of outstanding contributions to the largest criminal investigation and successful prosecution of a single physician, Dr. Jacques Roy, involving the submission of more than $375 million in fraudulent claims.” Sr. Vice President Scott Ward; Nurse Investigator and Law Enforcement Liaison Lisa Garcia, RN; and Clinical Educator and Law Enforcement Liaison Donna Large received the award at the Hubert H. Humphry Building in Washington, DC.

Quality Health Strategies CEO Dr. Ron Forsythe, Health Integrity President Sandy Love, Sr. Vice President Jaysen Eisengrein, and Sr. Vice President Carrie Ward attended the ceremony as well. “This was an unbelievable case,” said Scott Ward. “Lisa Garcia testified in the trial as the first witness. Her testimony was so strong that there was no cross-examination.”

According to the Department of Justice April 2016 press release (www.justice.gov/usao-ndtx/pr/dallas-doctor-and-three-dallas-area-home-health-agency-owners-convicted-running-large) “Jacques Roy, M.D., 58, of Rockwall, Texas; Cynthia Stiger, 53, of Dallas; Wilbert James Veasey, Jr., 64, of Dallas; and Charity Eleda, R.N., 55, of Rowlett, Texas, were each convicted of several various counts of health care fraud.

As part of his fraudulent activities, Dr. Roy “sold his signature” to process almost $375 million in false Medicare and Medicaid claims. He also signed off on services by more than 500 home-health agencies for 11,000 patients from January 2006 through November 2010.

“The case was investigated by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG), and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU). It was brought as part of the Medicare Fraud Strike Force supervised by the Criminal Division Fraud Section and the U.S. Attorney’s Office for the Northern District of Texas.”

“Although the award was presented to a small group,” continued Ward. “It really took a village to bring down Dr. Roy.” Investigators conducted over 700 beneficiary interviews in a span of about 5 months. Nurse Reviewers, Data Analysts, Project Support, Subject Matter Experts, and Law Enforcement Liaisons worked closely together combing through data, producing necessary documentation, and providing expert testimony. The Data team received 77 sample requests, which they processed in the 5-month time-period. The team conducted 72 Medical Reviews and processed 1,725 claims during the 9 months it took to investigate Dr. Roy. This showed the immense dedication of the ZPIC Staff to the Health Integrity mission.

U.S. District Judge Sam A. Lindsay sentenced Wilbert Veasey to 210 months in federal prison and order to pay $23,123,897.18 in restitution to Medicare and $506,880.08 in restitution to Medicaid. Jacques Roy is expected to be sentenced in late August 2017.

“We are proud of the work of our team and their part in this historic investigation and prosecution,” said Sandy Love. “They provide the same effort and achieve the same results for each and every case they work. Once again demonstrating the effect of the best people, providing the best solutions, achieving the best results.”

About Health Integrity

Headquartered in Easton, Maryland, Health Integrity www.HealthIntegrity.org is a wholly owned subsidiary of Quality Health Strategies www.qualityhealthstrategies.com and serves the entire nation in an effort to protect the fiscal and clinical integrity of healthcare systems. The company currently holds a number of federal contracts for detecting and combating health care fraud, waste, and abuse on a national and regional level.

Letters to Editor

  1. Carol Voyles says:

    Thank you for sharing this report. Perhaps I have become cynical and too influenced by the role of politics in our lives today, but I am not surprised at all to find Health Integrity headquartered in our blue state of Maryland and these white collar criminals headquartered in Texas.

    Everything is bigger in Texas, but to keep my mind open and functioning properly, please share a story encompassing the opposite parameters at your earliest convenience.

    Until then, thank you for all you do nationwide, and keep up the good work.

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