On Tuesday, February 28, 2017 the Department of Justice, U.S. Attorney’s Office, Northern District of Texas put out a Press Release which is preserved here for historical purposes:
Sixteen Individuals Charged in $60 Million Medicare Fraud Scheme
DALLAS – An indictment returned by a federal grand jury in Dallas last week, and unsealed today, charges 16 individuals with offenses related to their participation in a health care fraud scheme, announced John Parker, U.S. Attorney for the Northern District of Texas.
The defendants charged are:
Bradley J. Harris, 35, of Frisco, Texas
Amy L. Harris, 42, of Frisco, Texas
Melanie L. Murphey, 35, of Fort Worth, Texas
Patricia B. Armstrong, 33, of Coppell, Texas
Mark E. Gibbs, 46, of Lindsay, Texas
Laila N. Hirjee, 50, of Plano, Texas
Syed M. Aziz, 51, of Frisco, Texas
Reziuddin Siddique, 63, of Allen, Texas
Charles R. Leach, 64, of Arlington, Texas
Jessica J. Love, 37, of Gainesville, Texas
Ali Rizvi, 49, of Carrollton, Texas
Tammie L. Little, 55, of Brashear, Texas
Mary Jaclyn Pannell, 29, of Krum, Texas
Taryn E. Stuart, 32, of Sanger, Texas
Slade C. Brown, 47, of Plano, Texas
Samuel D. Anderson, 35, of Carrollton, Texas
Each indicted defendant is charged with one count of conspiracy to commit health care fraud. Twelve of the defendants are also charged with at least one other count related to the conspiracy.
“That tens of millions of dollars were stolen through fraud is shocking enough,” said U.S. Attorney Parker. “That these defendants used human life at its most vulnerable stage as the grist for this scheme displays a shocking level of depravity that this community simply cannot tolerate.”
The indictment alleges that from July 2012 to September 2016, Novus billed Medicare and Medicaid more than sixty million dollars for fraudulent hospice services, of which more than thirty-five million dollars was paid to Novus. Specifically, defendants submitted false claims for hospice services, submitted false claims for continuous care hospice services, recruited ineligible hospice beneficiaries by providing kickbacks to referring physicians and healthcare facilities, and falsified and destroyed documents to conceal these activities from Medicare.
Novus Health Services and Optim Health Services, Inc. were operated and co-owned by Harris, who was a certified public accountant without any medical licenses. Harris operated the two companies essentially as one. Licensed physicians who were paid Novus medical directors provided little to no oversight of Novus’s hospice patients. Care was directed primarily by Novus nurses and by Harris. Defendants who were not physicians would determine whether a beneficiary would be certified for, recertified for, or discharged from hospice; whether they would be placed on continuous care; and how and to what extent they would be medicated with drugs such as morphine and hydromorphone. These decisions on medical care were often driven by financial interest rather than patient need. The defendants would decide whether to place, keep, or discharge a beneficiary from hospice depending on how that decision would affect Novus’s ability to bill Medicare.
Physicians were recruited who would refer hospice patients in exchange for medical director salaries. Assisted living facilities, in exchange for patient referrals, were provided remuneration including Certified Nursing Assistants paid for by Novus to staff the facilities.
Novus medical directors would sign certificates of terminal illness indicating that they had determined that a beneficiary was eligible for hospice services regardless of whether this was true or not; prepare re-certifications of terminal illness for beneficiaries already on hospice, which falsely indicated that the beneficiaries continued to be hospice eligible; and routinely give medical directors’ login information to others to log into Novus’s electronic medical records database to create and sign physician orders for services that had not been performed or had not been performed by the medical directors.
Harris would direct that beneficiaries be placed on continuous care, whether the beneficiaries needed this service or not. This decision would often be made without any consultation with a physician. Continuous care physician’s orders were falsified and uploaded into Novus’s electronic medical records database. When a beneficiary was on continuous care, the Novus nurses would administer high doses of Schedule II controlled medications such as morphine or hydromorphone, whether the beneficiary needed the medication or not. The defendants and others obtained these Schedule II medications with “C2” prescription forms (used for the prescription of controlled substances) which had been unlawfully pre-signed by medical directors. One reason for this aggressive medicating practice was that Harris wanted to ensure that the beneficiaries’ medical records contained documentation that would justify billing Medicare at the higher continuous care billing rate. There were instances when these excessive dosages resulted in serious bodily injury or death to the beneficiaries.
An indictment is merely an allegation and defendants are presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law. If convicted, however, each count of conspiracy to commit health care fraud and substantive health care fraud count carries a maximum statutory penalty of 10 years in federal prison and a $250,000 fine.
The case is being 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).
Assistant U.S. Attorney Russell Fusco is prosecuting the case.
You may read the original Indictment here: https://www.justice.gov/file/942611/download
The Indictment has also been preserved here for historical purposes: