Employees at a Frisco-based hospice services company were handing out controlled substances "like candy" without professional supervision as part of a multi-million dollar healthcare fraud scheme, according to the U.S. Department of Justice.
Earlier this month, two doctors were sentenced to a combined 23 years in prison for their part in the fraud. The scheme flowed about $40 million in Medicare and Medicaid funds
to the company the two doctors worked for, Novus Health Services.
In May, a federal jury found several Novus Health Services employees guilty of conspiracy to commit healthcare fraud and other charges. This included Medical Directors Dr. Mark E. Gibbs and Dr. Laila Hirjee, as well as Novus registered nurse Tammie Little.
Early this month, Chief U.S. District Judge Barbara M.G. Lynn gave Gibbs a 13-year sentence in federal prison and said he’d have to pay $27,978,903 in restitution. Hirjee was sentenced to a decade in federal prison and ordered to pay $16,253,281. Little was slapped with 33 months in federal prison.
Prosecutors presented evidence at trial that showed the three Novus employees had helped CEO Bradley Harris defraud Medicare. The fraud was made possible, in part, by illegally admitting patients into hospice who didn’t need to be and submitting “materially false claims for hospice services,” according to the DOJ. Harris pleaded guilty before the trial and testified against the three former employees.
He testified in court that he and Novus nurses would decide which patients were admitted into hospice and what drugs to prescribe, instead of licensed medical professionals.
In a press release
“Healthcare fraud in general is a multi-billion dollar a year problem.” – Melinda Urbina, FBI
, U.S. Attorney Chad Meacham said: “These doctors allowed Bradley Harris — an accountant with no medical expertise — to dispense controlled substances like candy, with little to no medical oversight. They claimed to have had hands-on experience with hospice patients, when in fact, they’d entrusted life-or-death medical decisions to untrained businesspeople.”
Gibbs and Hirjee would document face-to-face examinations with these patients that didn’t actually occur, Harris said in court. They also prescribed Schedule II controlled substances like morphine, hydromorphone and fentanyl, with pre-signed prescription slips they’d give to Harris and others at Novus. This allowed them to prescribe the medication without physician oversight.
The Medicare payments to Novus were eventually suspended because of billing concerns. Harris, Gibbs and others then transferred employees and patients to a new hospice company and continued billing Medicare for the services, netting about $40 million.
“The defendants violated their Hippocratic Oath as doctors and instead focused on lining their pockets at the expense of patient safety,” FBI Dallas Special Agent in Charge Matthew DeSarno said in a press release. “This case highlights the importance of thoroughly investigating any complaint of healthcare fraud.”
Melinda Urbina, an FBI spokesperson, told the Observer
by email, “Healthcare fraud in general is a multi-billion dollar a year problem.”
Authorities are alerted to these schemes in a number of ways, including investigations sparked by insurance companies, as well as reports from the public, relatives of victims, employees or the perpetrators themselves.
“We encourage the public to help us identify, investigate, and prosecute this crime,” DeSarno said. If you suspect healthcare fraud, report it to the FBI at tips.fbi.gov, 1-800-CALL-FBI, or contact your health insurance provider.”
Several others charged in the case, including Harris’ wife Novus Vice President of Patient Services Amy Harris, Vice President of Marketing Samuel Anderson, and Director of Operations Melanie Murphy, pleaded guilty to various offense before the trial.
U.S. Attorney Meacham said, “We are satisfied to know they will spend the next decade behind bars.”