Home Health & Hospice Week

Plus: Home health cases snare physician, SNF worker fraudsters.

Five years after federal raids and four years after multiple Novus and Optimum Health Services hospice personnel were indicted, the Frisco, Texas hospice’s CEO has pled guilty in a fraud case that alleges tens of millions of dollars in false claims.

Bradley J. Harris, age 39, has 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, the Department of Justice says in a release. Harris “further admitted that he used blank, pre-signed controlled substance prescriptions to dole out potent drugs without physician input.”

Two physician co-conspirators were paid $150 kickbacks for each false certification of terminal illness and order they signed, Harris also admitted. And in an attempt to evade the aggregate hospice cap by enrolling an “influx” of new patients, Harris admitted to negotiating an agreement with a company called Express Medical that allowed him to access potential patients’ confidential medical information in return for using Express Medical for lab and home health services, according to the DOJ. Harris’ wife and other Novus staff then recruited those patients for Novus hospice services, regardless of whether they were eligible to receive benefits.

When the Center for Medicare & Medicaid Services suspended Novus, Harris simply transferred patients from Novus to a new company, which used Novus staff and transferred hospice reimbursements back to Novus, the DOJ adds.

The DOJ release doesn’t mention some of the salacious charges first named in the search warrant affidavit and the original indictment — namely, that Harris had staff intentionally overdose patients to hasten their death for financial gain under the cap; and that he texted with a nurse about that practice (see HCW by AAPC, Vol. XXVI, No. 9).

Harris is scheduled for sentencing on Aug. 3 and could face up to 14 years in prison, Justice says. Ten codefendants have already pleaded guilty while four more, including two referring physicians, are slated for trial on April 5.

Meanwhile: It’s not just the home health agency operators and personnel that are being called on the carpet in HHA fraud cases, two recent cases show.

Case #1: In Houston, a doctor of osteopathic medicine has agreed to pay $475,000 to resolve allegations that he certified home health patients in exchange for kickbacks. Primary care physician Truc Le “certified patients for home health services without any knowledge of the patients’ medical condition or homebound status,” the DOJ says in a release. “Instead, Le signed forms that Unified representatives provided to him on a regular basis.”

Unified “sent improper payments to Le in violation of the Anti-Kickback Statute,” the DOJ adds. “Medical professionals put the integrity of our federal health care programs at risk when they just rubber-stamp forms,” Acting U.S. Attorney Jennifer B. Lowery says in the release. “It is made worse when improper payments are the source of their motivation.”

Case #2: A director of social services at a skilled nursing facility in Roseville, California, accepted kickbacks in exchange for steering patients when helping them select an HHA at discharge, the DOJ says in a separate release. In her guilty plea, Mariela Panganiban admitted that HHA owners paid her cash kickbacks in exchange for the referral of about 100 beneficiaries. Medicare paid the agencies about $735,000 for those patients’ care.

Panganiban is scheduled for sentencing on May 20, according to the DOJ.