Lawsuits regarding healthcare fraud are rife in the news. Healthcare fraud expert witnesses are a central part of the litigation team in these cases. In the largest case of US home healthcare fraud involving one doctor, former Rockwall, TX, doctor Jacques Roy billed $375M in fraudulent claims. He encouraged patients to submit fake medical claims in return for cash and food and then subsequently billed Medicaid and Medicare. His 11,000 fake patients included the homeless in the largest home healthcare fraud in the history of the U.S. Department of Health & Human Services perpetrated by a single doctor.
A federal jury in Dallas found him guilty on eight counts of healthcare fraud, two counts of making a false statement relating to healthcare matters, one count of obstruction of justice, and one count of conspiracy to commit healthcare fraud. He could be sentenced to more than eighty years in prison.
A Department of Justice, U.S. Attorney’s Office, Northern District of Texas press release states:
The government presented further evidence at trial that the scope of Dr. Roy’s fraud was massive; Medistat processed and approved POCs for 11,000 unique Medicare beneficiaries from more than 500 different home health agencies. Dr. Roy entered into formal and informal fraudulent arrangements with Apple, Charry, Ultimate and other home health agencies to ensure his fraudulent business model worked and that he maintained a steady stream of Medicare beneficiaries.
Healthcare fraud is a serious crime, which may involve large amounts of money. Healthcare fraud expert witnesses are brought on board when medical malpractice involves a healthcare provider or physician violating healthcare ethics and/or health insurance policies. These experts are able to audit medical records, uncover bogus medical services billed to Medicare, Medicaid, and health insurance companies, and translate the nuances of their field in court testimony.