Hospice CEO Confesses to Falsifying Medical Care Claims and Inappropriate Medical Record Access

The ex – CEO of Novus and Optimum Health Services, which manages two hospices within Texas, pleaded guilty in a fraudulence case that resulted in the loss of tens of millions of dollars by Medicare and Medicaid because of bogus medical care claims submissions.

Acting U.S. Attorney Prerak Shah for the Northern District of Texas, lately reported that Bradley Harris, 39 years old, pleaded guilty to conspiracy to undertake medical care fraud and is currently awaiting his sentence.

Besides defrauding the federal healthcare services, the actions of Harris led to the denial of vulnerable patients to get the medical care they need, the approval of prescriptions for pain treatment without the doctor’s input, and the non-examination of terminally ill patients.

Harris confessed to charging Medicare and Medicaid for hospice services from 2012 to 2016 that were not rendered, not instructed by a medical specialist, or were given to people who were not qualified for hospice services. Harris additionally confessed to utilizing blank, pre-signed controlled substances prescriptions and giving the medications with no physician involvement.

Harris paid two coconspirators, Dr. Laila Hirjee and Dr. Mark Gibbs, $150 each for every fake order they sign and would frequently approve the hospice patients who had terminal conditions and a life expectancy of at least 6 months, with no need to get any assessments. Dr. Gibbs, Dr. Hirjee, and another doctor, Dr. Charles Leach, supplied blank prescription medications for controlled substances which permitted Harris to schedule beneficiaries their II-controlled substances from Medicaid and Medicare in the hospice with no need for consultations with a medical specialist at a cost

Harris additionally broke the Health Insurance Portability and Accountability Act (HIPAA) Guidelines when he gained access to the healthcare records of patients to determine people who can be contacted and provided Novus hospice services. In summer 2014, Harris discussed an agreement with Express Medical which permitted him to get access to the healthcare records of potential patients in exchange for utilizing the company for lab services and home health appointments. Harris’s wife then contacts the past patients of Express Medical and other hospice personnel to recruit them, no matter if they were really qualified for hospice services. This permitted Harris to get new hospice patients to steer clear of going above Medicare’s aggregate hospice limit.

The HHS’ Centers for Medicare and Medicaid Services obtained several reports of potential fraudulence and suspended Novus; nevertheless, Harris then moved patients from Novus to another hospice organization, which then moved back reimbursements for hospice services to Novus. Dr. Gibbs is known as the new hospice organization’s medical director.

Harris is slated to get his sentence on August 3, 2021 of around 14 years in prison. Dr. Gibbs, Dr. Hirjee and two more coconspirators are going to have their trial on April 5, 2021. 10 codefendants confessed and are waiting for sentencing for their part in the fraud. Dr. Charles Leach earlier pleaded guilty to one count of conspiracy to perform healthcare fraudulence in 2018, for his part in the $60 million scams case. Based on court files, the blank prescription medications Dr. Leach authorized were employed to get hold of controlled substances, high quantities of which were then given to patients by nurses to speed up their demise.

The Justice Department can’t permit unethical businessmen to get in the way of the practice of medicine. It is determined to take out healthcare scams. It is going to work tirelessly with the state and federal associates to make those who perform medical care scams responsible and get justice for people that are hurt by the fraud schemes, said FBI Dallas Special Agent in Charge Matthew DeSarno.