When it comes to healthcare fraud, there is nothing sacred. Unethical people have a need, they see an opportunity, they make bad choices and ultimately those choices have consequences. In Frisco, Texas the co-owners of a hospice company that runs Novus 
Health Services and Optim Health Services plus 14 others including five registered nurses and five physicians, were indicted in a Medicare fraud scheme. They are accused of fraud amounting to in excess of $60 million.
As I write this, I want to say that “nothing is sacred anymore,” when a hospice operation, of all things, fleeces the government for end-of-life services. However, I am not naïve when it comes to medical fraud. It can run rampant when ethical individuals turn their backs on unethical behaviors.
The attorneys for Samuel D. Anderson and Amy Harris, his wife are “reviewing the charges.” This is different than categorically denying the charges, but for now, that is their right given our legal system.
Need Hospice Care, or not?
Among the many other charges against the hospice operations are that a small group of physicians, in synchrony with Novus Health Services, certified that some of their patients needed continuous, end-of-life hospice care when they did not. I will forego talking about the psychological ethics issues to the patients and their families and instead focus on the financial issues.
When patients who may not have needed continuous hospice care were referred into what I shall call this “continuous care hospice protocol” rather than routine hospice care or even no hospice care, Medicare paid a higher daily rate to the facilities. As the case goes back to 2013 we will talk in terms of 2013 dollars.
It is a bit confusing due to terminology, but some terminal patients essentially need routine care and comfort, while other terminal patients need continuous care. According to quoted pricing data, in 2013, hospice patients just needing only routine care potentially brought in $153 per day to Novus in Medicare payments, while continuous hospice rates brought in from $303 to $895 per day.
Here is where this unethical scam turned really ugly. In order to mask their lack of ethics, nurses at the hospices were giving patients drugs such as morphine whether the patients needed it or not. Here is the more horrible result, if that is possible: some of the patients who didn’t need drugs died as the result of drug overdoses. One U.S. Attorney called it “depravity,” while I might use the term “pure evil.”
The scam operated from July 2012 to September 2015. In total, they billed the government more than $60 million for fraudulent hospice services. The government paid Novus more than $35 million of those claims.
Among the Charges
There are many charges filed against the clinics. In addition to the false claims discussed above it was found that the referring physicians received kickbacks and that documents attesting to the fact that the hospice patients needed continuous care were intentionally destroyed!
Not only were the physicians offered under the table payments from Novus, once the referrals were made the physicians essentially gave up all responsibility and turned it over to nurses at the facility. Now for the icing on this horrid cake: it was a CPA who determined the extent of treatment. How or why this was allowed to happen is a further example of extremely poor choices.
The physicians are now trying to cover their tracks. They claim they personally met with patients face-to-face to make certain they were certified for continuous hospice care. That is all well and good, but on the dates they were supposed to have signed the forms, some of them were allegedly away or on vacation.
In text messages between referring physicians who had never seen the patients and the nurses who gave drugs, there were very angry exchanges. Ultimately, the physicians realized how badly they lost control. I believe this was the beginning of the end. The physicians and registered nurses would have been fools to not see what was coming and to realize where their choices had led them.
As the result of the numerous violations of medical ethics, the FBI, the U.S. Department of Health and Human Services and the Texas attorney general’s Medicaid Fraud Control Unit are investigating this case, especially the husband and wife team at the top.
In addition to the agencies above, I would imagine the state medical and nursing societies and possibly, even the agency responsible for CPA licensing will become involved. Ultimately, patients died. Human life was lost because greed was allowed to triumph over ethical responsibility.
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Any updates?