Home Health & Hospice Week

A federal jury has convicted two hospice medical directors and an RN of health care fraud in the high-profile Novus Health Services case.

The convictions after a five-day trial come five years after federal raids and four years after multiple Novus and Optimum Health Services hospice personnel were indicted. Novus CEO Bradley Harris and Director of Operations Melanie Murphey, both of whom already have pleaded guilty in the case, testified against physicians Mark Gibbs and Laila Hirjee, and Novus RN Tammie Little.

At trial, Harris said he and Novus nurses, including Little, determined which patients would be admitted to or discharged from hospice care, as well as which drugs and dosages they would receive, the Department of Justice says in a release. In exchange for kickbacks disguised as medical director payments, Gibbs and Hirjee certified that they had examined patients face-to-face when they hadn’t; pre-signed blank C2 prescriptions and gave them to Harris and others at Novus to let them prescribe controlled substances without any physician oversight; and furnished referrals. “I was the doctor,” Murphey said at trial, according to the DOJ.

When Medicare suspended payment to Novus, the defendants moved patients and employees to a new hospice company and continued to bill Medicare for hospice services, the release says. They also violated HIPAA to recruit beneficiaries and destroyed documents to conceal the fraud.

Twelve codefendants in the case, including other medical directors, nurses, and marketing staff, have already pleaded guilty, Justice notes. Harris is scheduled for sentencing Aug. 3.

“With today’s guilty verdicts, we are one step closer to bringing this sordid case to a close,” said Acting U.S. Attorney Prerak Shah. “These medical professionals behaved unconscionably, allowing Mr. Harris — an accountant — to dictate end-of-life care for suffering patients. The Northern District of Texas will not stand for this sort of misconduct.”

$6M In False Claims Due To False Certs

Meanwhile in California, authorities have arrested a Los Angeles-area physician for exchanging bogus home health certifications for kickbacks. In addition to receiving cash for the certs from four home health agencies, Lilit Gagikovna Baltaian also billed Medicare for them, as well as other items and services she didn’t furnish, the DOJ says in a release.

The resulting false claims submitted by the HHAs resulted in more than $6 million in payments, according to Justice.