A jury has found two medical directors and one nurse from Dallas-based Novus Health guilty of conspiracy to commit health care fraud in a scheme that bilked close to $40 million from Medicare. The U.S. Department of Justice accused Mark E. Gibbs, M.D., Laila Hirjee, M.D., and nurse Tammie Little of aiding Novus CEO Bradley Harris defraud Medicare by submitting materially false claims for hospice services, providing kickbacks for referrals, violating HIPAA to recruit beneficiaries, and destroying documents to conceal the evidence.
Harris was convicted in March and is awaiting sentencing at a hearing scheduled for Aug. 3. He could be sentenced to as many as 14 years in prison. In addition to the conspiracy charge, Gibbs was convicted of two counts of health care fraud and one count of obstruction of justice. Likewise, Hirjee received a guilty verdict for three counts of fraud and one drug offense. The physicians allegedly left blank, signed prescription pads that Harris used to provide controlled substances to patients, even though he is not a physician or licensed independent practitioner. Little was found guilty of three fraud counts.
Gibbs was acquitted of a third fraud charge despite being convicted for the other two.
“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.”
The U.S. Department of Human Services Office of the Inspector General (OIG) and the U.S. Department of Justice in recent years have increasingly scrutinized hospice providers for compliance with anti-fraud measures. Many organizations have come under legal and regulatory attention related to medical necessity complaints under the False Claims Act. Similar to a case involving Texas-based Merida Health Group, investigators found that Novus representatives lied to patients and families about their health status, indicating death was imminent when it was not.
The FBI’s Dallas field office investigated the crimes in collaboration with OIG and the Texas Attorney General’s Medicaid Fraud Control Unit. A total of 10 individuals have pled guilty in the case.
Harris admitted to knowingly exceeding the Medicare aggregate hospice cap in 2014 by enrolling an influx of patients, negotiating an agreement with vendor Express Medical Supply that allowed the former CEO to access confidential patient medical information in exchange for using the company’s laboratory services and home health visits. Harris’ wife and other Novus staff contacted individuals with this information to bring them on as hospice patients, regardless of whether they were eligible to receive the benefit or needed end-of-life care.
At his own trial, Harris testified that he and Little, rather than physicians, decided which patients would be admitted to or discharged from the Novus hospice program and which drugs and dosages they would receive. He further indicated that Novus doctors, including Gibbs and Hirjee, signed certification documents for patients without conducting the required face-to-face examination, according to the Justice Department. Harris said he paid those physicians kickbacks for enabling the fraud.
Novus Director of Operations Melanie Murphey was also involved in falsely certifying patients. “I was the doctor,” she testified at trial.
Hirjee faces as many as 60 years in federal prison. Little and Gibbs could be sentenced to 40 years and 35 years, respectively.
Companies featured in this article:
