U.S. District Judge Sam Lindsay sentenced the owner of a Dallas home health care company to 17 years in federal prison Tuesday for his role in what authorities have called the biggest instance of home health care fraud in the history of Medicare and Medicaid. Lindsay also ordered Wilbert James Veasey Jr., 65, to pay more than $23 million in restitution to Medicare and more than $506,000 in restitution to Medicaid.
According to federal prosecutors, Veasey and his co-defendants, Jacques Roy, Cynthia Stiger and Charity Eleda, "engaged in a large-scale, sophisticated health care fraud scheme in which they conspired together and with others to defraud Medicare and Medicaid through companies they owned/controlled: Medistat Group Associates, P.A., Apple of Your Eye Health Care Services, Inc., Ultimate Care Home Health Services and Charry Home Care Services."
The scheme went like this: Veasey, Stiger and Eleda improperly recruited individuals with Medicare to fraudulently sign up for Medicare home health services. Prosecutors said Veasey usually trolled for sign-ups by going door-to-door. Eleda took things further, prosecutors said, bribing residents of The Bridge homeless shelter with McDonalds so that they would visit Eleda's van outside the shelter's gates. Eleda, a nurse, would falsify documents with other nurses to make it seem like a prospective patient was eligible for home health services that weren't medically necessary.
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Roy, a doctor, then had his staff certify the plans of care developed for the fraudulent home health patients, signing off that he found the treatment to be medically necessary. The doctor and his employees did this for thousands of patients of Roy's practice, Medistat — so many that "Medistat’s office included a '485 Department,' essentially a 'boiler room' to affix fraudulent signatures and certifications," prosecutors say.
After plans for the patients were certified, nurses employed by Veasey or Stiger and Eleda created false notes to make it look like skilled nursing services were being provided to patients and were still necessary. Roy often visited people who signed up to order unnecessary medical services.
Authorities began investigating Roy when a federal data analysis showed he'd submitted about 11,000 claims for unique Medicare beneficiaries, dozens of times more than is typical for any doctor, running up about $374 million in Medicare and Medicaid claims. They arrested him in 2012.
Roy, Stiger and Eleda have also been convicted of conspiracy to commit health care fraud, as well as health care fraud, and are awaiting sentencing.