Home Health & Hospice Week

Physicians must call the shots, case stresses.

Get ready to defend your hospice medical director relationships, thanks to a Texas case alleging serious fraud and abuse related to physicians.

The feds have indicted 16 people on fraud charges in a case involving hospice Novus Health Services in Frisco, Texas (see story, p. 68). And five of those people are physicians who served as Novus medical directors: physicians Mark Gibbs, Laila Hirjee, Syed Aziz, Reziuddin Siddique, and Charles Leach.

According to the indictment unsealed Feb. 28, the docs in the case went far beyond just accepting payment for steering hospice patients Novus’ way. For one, they willingly abdicated their roles in directing patients’ care. “Licensed physicians who were paid Novus medical directors provided little to no oversight of Novus’s hospice patients,” the Department of Justice says in a release. “Care was directed primarily by Novus nurses and by [Novus owner and CPA Brad Harris]. Defendants who were not physicians would determine whether a beneficiary would be certified for, recertified for, or discharged from hospice; whether they would be placed on continuous care; and how and to what extent they would be medicated with drugs such as morphine and hydromorphone.”

“These decisions on medical care were often driven by financial interest rather than patient need,” the DOJ continues. “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 docs also actively participated in falsifying documentation for ineligible patients, the feds allege. After an ineligible patient was identified and admitted, the docs would sign Certifications of Terminal Illness for them whether they qualified or not. The docs also collaborated with Novus staff to sign false recerts, the indictment says.

Gibbs and Hirjee signed face-to-face encounter documents for times they couldn’t have done them. For example, Gibbs signed 19 F2Fs indicating he would have traveled 200 miles to 19 different locations by 1:30 p.m. one day. And Hirjee signed F2Fs for days she was traveling to places like Hawaii and Mexico, according to the indictment.

The docs also gave Novus staff their login information for electronic medical records so Novus could create false records for them. The feds offer as proof a text exchange between Harris and Gibbs about his password, and a text exchange between Harris and Director of Operations Melanie Murphey where he complains he can’t log in as Aziz and she replies, “Like I literally just did it. I just logged in to sign orders.”

The docs also furnished pre-signed prescription forms for controlled substances, which Novus used to unnecessarily administer high levels of morphine and similar meds to patients who were on CHC. “These excessive dosages resulted in serious bodily injury or death” in some cases, the indictment says.