A large-scale fraud scheme uncovered earlier this year sheds light on just how vile healthcare administrators can be in their pursuit of financial gain. Novus and Optim Health Services, a hospice provider based in Texas, were found to have submitted over $60 million in false claims to both Medicare and Medicaid – a scheme that is made only more heinous by the actions of the owners, who repeatedly encouraged over-administration of drugs in order to continue billing for patients that would have otherwise not been deemed eligible for care under government standards.
The purposeful overdosing of drugs such as morphine and hydromorphone resulted in several fatalities over the course of the three-year scheme, as well as countless injuries. According to the attorney’s announcement, the aggressive medication practices employed by Novus were “to ensure that the beneficiaries’ medical records contained documentation that would justify billing Medicare at the higher continuous care billing rate,” though it was proven that the administered medications were altogether unnecessary in most cases. Perhaps even more disturbing, the nurses who reported the deaths were often congratulated by the owner; one nurse reported that, upon relaying the news of a patient’s death to the owner, she received a text message in response that simply read, “Nice work.”
Unfortunately, the practice of expediting patients’ deaths was not enough for the owners of these hospice chains, who allegedly committed various other fraudulent acts in their efforts to bilk the government healthcare programs. According to reports, Novus offered salaries or other forms of payment to physicians and assisted care facilities alike in return for patient referrals that would have otherwise been sent elsewhere. In email exchanges involving one of the facility’s medical directors, it was unveiled that patients were regularly sent to Novus and Optim alike in return for promotions or pay raises; the indictment itself quoted one of these emails, which stated in part, ‘”My goal was to send as much business to [the owners] in return for directorships, etc.”
Further, the staff would often falsely certify patients for hospice based upon visits that did not actually take place; in one example, a medical director signed nineteen certifications in one day that would have required him to travel almost 200 miles before 1:30 p.m. Another employee of Novus alleged that she completed face-to-face evaluations in Texas on dates that she was on vacation in Mexico or Hawaii. The indictment further stated that physicians employed by the hospice facility habitually provided “little to no oversight” of their patients, with many important medical decisions being made by the owner, who has no medical background.
Though the recovery of the $35 million doled out by the two government healthcare programs is certainly a victory for the U.S. Department of Justice, the blatant neglect for the well-being of patients involved in these fraudulent schemes continues to be a concern. “That tens of millions of dollars were stolen through fraud is shocking enough,” said U.S. Attorney John Parker. “That these defendants used human life at its most vulnerable stage as the grist for this scheme displays a shocking level of depravity that this community simply cannot tolerate.”
Whistleblower Justice Network Can Help You
Whistleblower Justice Network partners with whistleblowers to bring to justice those who prioritize financial gain over moral responsibility. We assist individuals who bring forth information about fraudulent schemes in filing cases against those who knowingly risk patient lives in order to illicitly obtain funds.
If you have meaningful information regarding hospice fraud that you believe is in violation of the False Claims Act, Whistleblower Justice Network can help. Working alongside world-class legal counsel, we will ensure you are protected to the fullest extent of the law and that you receive credit for the information you bring to the U.S. government. Partnering with whistleblowers is all we do. Visit us at www.whistleblowerjustice.net, or call us at 844-WJN-4ALL.