TX hospice indicted for $60M fraud, overmedicating

A North Texas hospice services company is in hot water for providing hospice care services and controlled pain medications that were not necessary in order to bill Medicare at higher rates. Novus Health Services and its sister-company Optim Health Services, Inc. allegedly billed Medicare for more than $60 million in fraudulent claims between July 2012 and September 2016, according to a release from The U.S. Attorney’s Office for the Northern District of Texas.

A federal grand jury indicted Bradley J. Harris and Amy L. Harris, the couple that owned and operated Novus. Of the 14 other people charged, five are physicians and five are nurses, noted the Dallas News.

Among the charges of upcoding and delivery of unnecessary services are:

  • Admitting patients that didn’t need hospice care, including the creation of fake Certificates of Terminal Illness
  • Providing pay-offs for referrals from assisted living and other physicians
  • Billing at the “continuous care” level using false supporting evidence
  • Overmedicating and/or administering Schedule II pain medications to those who didn’t need them. “There were instances when these excessive dosages resulted in serious bodily injury or death to the beneficiaries,” the U.S. Attorney’s Office stated.

The scheme also recruited physicians who would refer hospice patients in exchange for medical director salaries. Assisted living facility personnel were also compensated in exchange for patient referrals, including Certified Nursing Assistants paid for by Novus to staff the facilities. “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,” the U.S. Attorney’s Office release said.

“That tens of millions of dollars were stolen through fraud is shocking enough,” said John Parker, U.S. Attorney for the Northern District of Texas. “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 case is being investigated by the Federal Bureau of Investigation, the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) and the Texas Attorney General’s Medicaid Fraud Control Unit.

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