The former CEO of a Texas hospice service recently pled guilty for his role in defrauding Medicare and Medicaid out of tens of millions of dollars in falsified claims. Bradley J. Harris, who ran Novus Health Services and Optim Health Services, Inc., awaits a sentencing hearing on August 3 of 2021. He faces a prison sentence of up to 14 years. The details of the Medicare and Medicaid fraud are described below.

Medicare and Medicaid Fraud: The Facts

In 2017, Bradley J. Harris, then-CEO of hospice services Novus Health Services and Optim Health Services, Inc., was indicted on fifteen counts of healthcare fraud and conspiracy to commit healthcare fraud.

Medicare and Medicaid Fraud

Recently, Mr. Harris pled guilty. In his plea papers, Mr. Harris:

  • Admitted to personally falsifying records for Medicare and Medicaid hospice services from 2012 to 2016 that were not actually provided;
  • Admitted to personally falsifying records for Medicare and Medicaid hospice services from 2012 to 2016 to patients not eligible for hospice benefits;
  • Admitted to using blank, pre-signed controlled substance prescriptions to issue potent pain medications without physician input (Mr. Harris is an accountant, and has never been a licensed medical professional).

Mr. Harris also admitted that two of his co-conspirators, Dr. Mark Gibbs and Dr. Laila Hirjee, frequently certified that “his” hospice patients faced terminal illnesses without actually examining  the patients in person, as required by Medicare. These doctors were paid approximately $150 for each false certification. These acts were part of the scheme to commit Medicare and Medicaid fraud.

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The Fraudulent Scheme

To commit Medicare and Medicaid fraud, Mr. Harris had to get  around the problem of not being a licensed physician. So, he had  Drs. Gibbs, Hirjee, and a Dr. Charles Leach, leave him blank controlled substance prescriptions. Mr. Harris would then “prescribe” these prescriptions. This practice is known as the unlawful practice of medicine.

Mr. Harris also got other companies in on his scheme. In 2014, he realized that he could avoid exceeding the Medicare aggregate hospice cap. The hospice cap limits the number of days of inpatient care for which a hospice can bill Medicare to no more than a certain percent of “total Medicare days.” Mr. Harris got around the cap by enrolling a fresh batch of first-time hospice patients. He entered into an agreement with a company called Express Medical that allowed him, in violation of the HIPAA regulations, to access potential patient PHI. In return for enabling this theft, Express Medical let him recruit prior and current patients for Novus “laboratory services and home health visits.” The individuals were recruited regardless of their benefit eligibility. 

As a result of Mr. Harris’ fraudulent activities, a number of terminally ill patients were left unexamined. In some cases, the deaths arrived too slowly for Mr. Harris’ liking: One nurse claimed she was following his orders when she drugged two patients to hasten their deaths. Among the evidence against Mr. Harris was a text message that Harris allegedly sent the nurse about a patient, stating, “he better not make it tomorrow. Or I will blame u.”

 “Mr. Harris scammed federal healthcare programs out of millions of dollars, and worse yet, denied vulnerable patients the medical oversight they deserved, writing pain prescript