Novus Hospice CEO Pleads Guilty to Healthcare Fraud
The CEO of a local hospice agency has pleaded guilty to defrauding Medicare and Medicaid, announced Acting U.S. Attorney for the Northern District of Texas Prerak Shah.
Bradley J. Harris, the 39-year-old former head of Novus and Optimum Health Services, pleaded guilty on Friday to conspiracy to commit healthcare fraud and healthcare fraud.
“Mr. Harris scammed federal healthcare programs out of millions of dollars, and worse yet, denied vulnerable patients the medical oversight they deserved, writing pain prescriptions without physician input and allowing terminally ill patients to go unexamined,” said Acting U.S. Attorney Prerak Shah. “The Justice Department cannot allow unscrupulous business people to interfere with the practice of medicine. We are determined to root out healthcare fraud.”
“In addition to causing fraudulent billing for tens of millions of dollars, Mr. Harris preyed upon patients and families that did not have a true understanding of Novus and hospice services. The core of the company was rooted in deception, and the lack of physician oversight allowed Mr. Harris to make medical decisions for his own financial benefit,” said FBI Dallas Special Agent in Charge Matthew DeSarno. “We will continue to work tirelessly with our state and federal partners to hold those who commit health care fraud accountable and seek justice for patients that are harmed in furtherance of fraud schemes.”
According to his plea papers, Mr. Harris admitted that from 2012 to 2016, he billed Medicare and Medicaid for hospice services that were not provided, that were not directed by a medical professional, or that were provided to patients who were not actually eligible for hospice care. He further admitted that he used blank, pre-signed controlled substance prescriptions to doll out potent drugs without physician input.
Mr. Harris admitted that two of his coconspirators, Dr. Mark Gibbs and Dr. Laila Hirjee, frequently certified that that his hospice patients faced terminal illnesses without actually examining with the patients in person, as required by Medicare. (A “terminal” patient is one with a life expectancy of six months or less, according to the Department of Health & Human Services.) The doctors were paid around $150 for each false order they signed.
Mr. Harris also admitted that Dr. Gibbs, Dr. Hirjee, and another physician, Dr. Charles Leach, left him blank controlled substance prescriptions, sometimes a whole pad at a time. This allowed Mr. Harris, an accountant by trade, to “prescribe” schedule II controlled substances to hospice beneficiaries without the guidance of a medical professional.
In plea papers, Mr. Harris admitted that in summer 2014, he realized he could avoid exceeding Medicare’s aggregate hospice cap by enrolling an influx of first-time hospice patients. So, he negotiated an agreement with a company called Express Medical that allowed him to access potential patient’s confidential medical information in return for using Express Medical for laboratory services and home health visits. His wife and other Novus staff then called on individuals that had at some point been patients of Express Medical to recruit them for Novus hospice services, regardless of whether they were eligible to receive benefits.
When the Center for Medicare & Medicaid Services suspended Novus based upon credible allegations of fraud, Mr. Harris and simply transferred patients from Novus to a new company, “Company A.” Dr. Gibbs became a medical director for the “new” hospice company, which used Novus staff and transferred hospice reimbursements back to Novus, Mr. Harris admitted.
The defendant now faces up to 14 years in federal prison. His sentencing hearing has been set for Aug. 3 before Chief U.S. District Judge Barbara M.G. Lynn.
Ten of Mr. Harris’ codefendants, including Dr. Leach, have already pleaded guilty. Four more, including Dr. Gibbs and Dr. Hirjee, are slated for trial on April 5.
The Federal Bureau of Investigation’s Dallas Field Office, the U.S. Department of Health & Human Services Office of Inspector General (HHS-OIG), and the Texas Attorney General’s Medicaid Fraud Control Unit conducted the investigation. Assistant U.S. Attorneys Donna Strittmatter Max, Marty Basu, and Chad Meacham are prosecuting the case.