Associated Press
Published on March 1, 2012
Authorities say Jacques Roy and six others indicted for health care fraud certified 11,000 Medicare beneficiaries through more than 500 home health providers over five years. Those numbers would have made Roy's Medicare practice the busiest in the country. But an investigation into Roy and his business practices didn't begin until about a year ago, officials said.
The federal agency that administers Medicare has two sets of contractors: one to pay claims and another evaluating those claims for fraud. U.S. Health and Human Services investigators have found that health officials often have a hard time tracking the work of contractors that are supposed to detect Medicare fraud — estimated by some to reach $60 billion annually.
Federal officials who announced the indictment against Roy and six others in Dallas acknowledged the problems with the system. They contend they have improved data analysis and are working to move away from having to "pay and chase" offenders.
Others say Medicare is still very vulnerable to fraud.
"It's a trust-based system that is ripe for the picking by criminals," said Kirk Ogrosky, a Washington, D.C., attorney at the law firm Arnold & Porter and a former top health care prosecutor at the U.S. Department of Justice.
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