A Texas Hospice Provider’s Deadly Scheme, Part 1

[00:00:01] Bob: This week on The Perfect Scam.

[00:00:03] Tom Cook: And, and the text ends with, with a text that says, "If, if we're going to be dirty, I want to be real dirty."

[00:00:10] Bob: "If we're going to be dirty, I want to be real dirty." Wow.

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[00:00:16] Bob: Welcome back to The Perfect Scam, I’m your host Bob Sullivan. Hospice is a beautiful, essential service that can help families deal with an incredibly difficult and sensitive time in life. It can allow death with dignity for people who are terminally ill. Back in the 1980s, the U.S. extended hospice coverage to Medicare patients, ensuring that more Americans would have access this critical benefit. Unfortunately, unscrupulous operators often try to cheat Medicare through criminal enterprises – and hospice benefits have been a target of such criminals. Now, stealing billions from taxpayers is bad enough, but sometimes, these criminals actually put patients and their healthcare at risk – and in today’s story, you’ll hear about an almost unthinkable crime. A company so desperate to steal from Medicare that its CEO actually instructed doctors and nurses to take steps designed to make the patients die faster so the firm would be more profitable. But thanks in part to our first guest, they didn’t get away with it.

[00:01:30] Judy Venable: Um, my mother retired from Neiman Marcus, she worked in the ladies ready-to-wear. She was a seamstress as well. But her primary job function was in sales.

[00:01:41] Bob: That’s Judy Venable-Grogan, who lives in Tyler, Texas. about 90 minutes east of Dallas. When her mother got older, she decided to do whatever she could to keep her at Judy’s home in Tyler.

[00:01:53] Judy Venable: Well I had promised my parents, my dad especially, that I'd take care of Mother, and I had always told Mother that I would never let her go to a nursing home. I mean there's good ones, so, but I had wanted to do this for my mother.

[00:02:08] Bob: A series of health problems had already piled up for mom -she’d been diagnosed with congestive heart failure and advanced arthritis. But when she slipped and fell and hit her head, well that caused a concussion. She recovered, but she had memory issues, making a complicated situation even harder.

[00:02:26] Judy Venable: Mother was very confused. It was hard for me because she didn't know who I was one minute uh to the next, and I could be her mother, from her perspective. I could have been her sister. I was never her daughter because she was trapped somewhere in the '40s. And that was during the war. Uh the other thing that was really, really hard was that around 3 to 4 o'clock in the afternoon, someone who has dementia or mental issues will have what they call sundowners. And their dementia will become worse. And she would go into a panic because her children weren't home from the school. And at first, I would explain to her, "Well Mom, I'm right here." And she said, "Well you're not my daughter," and finally I realized and for someone who's caring for a patient like this, it's really hard to basically lie to them, but it was easier for her. I got where I would just simply say, "Let me go call the principal at the school and see what's wrong," and then I would come back and say, "The bus is running late. Your children will be here shortly." And then she would be fine. Um, that was real hard for me to get to that point where we basically would play act these scenes out in her mind. I would try to figure out where she was, and, and what timeframe.

[00:04:04] Bob: I have to tell you though, that sounds so loving on your part. It just does.

[00:04:09] Judy Venable: I love my mother very, very much.

[00:04:14] Bob: Judy had help from a hospice home care aide. Someone would come often to help bathe and feed her mom. But she didn’t think the hospice company was responsive enough. It seemed reluctant to order new tests for mom, for example. Meanwhile, she’d heard about a new hospice provider that was growing fast – it had quickly become one of the largest hospice providers in all of North Texas. It was called Novus Health Services. After speaking with the firm, she decides to switch.

[00:04:45] Judy Venable: They were very willing to talk about any test. They had indicated to me that if there was a need to have what they call um, respite care, and that's for the caregiver, if the caregiver needs to have a break, they would make arrangements to transmit or transport the patient and they have always been willing to do that.

[00:05:05] Bob: Things are much better with Novus at first but after a couple of months, there is a dramatic change. Suddenly, Novus becomes less cooperative, too. Nurses are reluctant to order new tests, or to reconsider some medications. And mom, she seems to be getting worse. She’s struggling with digestive issues, her cognitive decline seems to be accelerating. And meanwhile, Judy finds it hard to connect with a doctor, even on the phone.

[00:05:34] Judy Venable: I kept trying to figure out why all of a sudden is this going south? And the hospice company was making it my fault.

[00:05:44] Bob: Making it all her fault by bluntly telling Judy she was clinging too hard to her mom.

[00:05:51] Bob: So they would, they would blame you, give you the idea you were being too difficult? What would they do?

[00:05:57] Judy Venable: I was told that I did not want my mother to die. I mean let's face it, even if someone's really ill and they're in a great deal of pain, you still don't want your loved one to die. But they accused me of that in a way that it was a negative. That I was resisting the dying process. I, I was too overprotective. I can't think of all of the words that they used, but...

[00:06:25] Bob: But you wanted just what anyone would want standard care for...

[00:06:27] Judy Venable: Right.

[00:06:29] Bob: And they were accusing you of clinging too much to your mom?

[00:06:31] Judy Venable: Right, the, example. The chaplain said, "Judy, we don't think that you want your mother to go. Have you asked her, have you told your mother that it's okay for her to pass away?" And of course, my comment to him was that I think I've told her that so many times, she thinks I'm trying to push her there.

[00:06:49] Bob: Judy is a very organized person, so she spends a lot of energy tracking her mom’s care. And Novus…well, they even question that.

[00:06:59] Judy Venable: I would write down what her blood pressure or her temperature or her oxygen on a, like a little sticky note, and that way I would have it. Having been in management and very familiar with reporting, I created an Excel spreadsheet where I was able to track all of that and keep it really, it was there on my laptop so when they called I would be able to pull it up and give them that information. I was told by the chaplain that that was over the top, those were her exact words.

[00:07:31] Bob: As time progresses, Novus caregivers even ask Judy to stop basic treatments.

[00:07:39] Judy Venable: The social worker asked me if I would consider telling them not to give Mother any antibiotics. And I asked why, and she said, "Well, a lot of parent, patients family will do that so that they will go ahead and basically let go faster" because Mother kept getting UTIs. Well it was, my sister and I discussed it, and so we talked with a counselor and chaplain, and he said, "Judy, go back and tell them that that's the doctor's decision." She brought it up again, "Have you thought about that more?" I said, "Well, yes, and actually we have a decision, that's the doctor's decision as to whether or not whether mother’s administered that medicine or not."

 

[00:08:24] Bob: Meanwhile there is no doctor to talk to. Hospice care does include regular meetings with a doctor, to discuss major treatment decisions. But Novus just won’t set up an appointment with a doctor. Judy starts to think something is really, really wrong.

[00:08:41] Judy Venable: I couldn't put my finger on it. And it was when there was this big pushback about getting tests for Mother. Every time we would ask for a doctor, they said they would fax him. His name between my sister and I was Dr. Fax.

[00:09:04] Bob: There was more than Dr. Fax. Novus just started pushing back on everything.

[00:09:11] Judy Venable: The pushback came on an aide being with Mother all the time. Pushback came back on getting physical therapy. So it was all around expense for them. And that got me to thinking, I guess, that there has to be something wrong, and why are they not sending a doctor out here?

[00:09:29] Bob: All the while, mom just keeps getting sicker and sicker and many times it looks like the end.

[00:09:34] Judy Venable: I had a recliner that I kept in the bedroom where after the nurses would finish taking care of her, I would go in the afternoon, and we would watch television together and, you know, we were together then. But the, the nurses, going back to the continuous care, they give the patient, they take them off of all food, they take them off of all of their normal meds, and they started administering morphine or hydromorphone to lessen the pain. And then normally the patient just lets go and, and passes away. And in Mother's case, I think four times the chaplain came and administered what might have been considered to be last rites, but Mother would fight back and never let it go.

[00:10:20] Bob: Eventually Novus calls what Judy describes as a “Come to Jesus” meeting with her and her sister Joyce. And the company leans pretty hard into this idea of about ceasing some medical treatments. Judy refuses.

[00:10:33] Judy Venable: Well that wasn't the answer they wanted. And at that point Joyce and I made the decision to change hospice companies, thank God. I knew something was wrong.

[00:10:40] Bob: Judy knows something’s wrong. And when she changes providers, mom gets to see a doctor almost immediately and it becomes obvious what is wrong. For starters, the doctor says, her mom needs to get weaned off the opioids she’s been taking.

[00:10:55] Judy Venable: The doctor staff, their primary goal at that particular point was to get Mother off of the Fentanyl and the uh all of the medication that she was on to medicate her.

[00:11:08] Bob: They basically turned your mom into a drug addict, my God.

[00:11:11] Judy Venable: Exactly

[00:11:12] Bob: Oh my God.

[00:11:13] Judy Venable: Novus had Mother so overmedicated on Fentanyl and Codeine that they had to put her on Methadone which is used to help addicts basically come off drugs. And, Mother was pretty much in almost a comatose state at this point.

[00:11:42] Bob: Thank God you changed providers.

[00:11:44] Bob: And there’s more.

[00:11:47] Judy Venable: The other thing that was going on is I kept telling the Novus nurses that Mother had this really bad diarrhea. And it was constant. And they said it was because I was giving her too much of the nutritional drink called Boost. And I said, well Mother was drinking Boost way before she ever went on hospice, but that was the debate and pushback that we had. When we interviewed the new hospice company, the nurse asked if there was anything else that I wanted to share? And I said, "Sure." I said, "Please, Mother has this really, really bad diarrhea, I mean it's almost constant. Mother had laid in that bed with constant diarrhea, and they wouldn't do any kind of testing. It wasn't the Boost. Within 24 hours of after getting Mother on the correct antibiotic, she started coming out of this pain that she had. And as the Methadone began to help her come off of the addiction to the medications, she became my mother again.

[00:12:57] Bob: As Judy watches her mother improve with the new care, she just can’t shake what happened at Novus. It was gnawing at her. So, eventually, she figures out who to complain to. She sends a letter to Social Security, to Medicare, complaining about her mom’s treatment.

[00:13:13] Judy Venable: It kept bugging me. So, I decided to write the letter, and never really thought of it after I put it in the mailbox.

[00:13:24] Bob: Well, that letter eventually lands in the hands of an FBI agent who, Judy doesn’t know, is already asking questions about what is happening inside Novus.

[00:13:34] Tom Cook: My name is Special Agent Thomas Cook. I'm an FBI Special Agent assigned to the Dallas Division.

[00:13:40] Bob: And what does your work generally involve?

[00:13:43] Tom Cook: I have, I was assigned to the Healthcare Fraud Squad here in Dallas for about five years, from 2015 until 2020.

[00:13:51] Bob: By the time Tom starts looking into Novus, other federal agents have already started investigating this fast-growing hospice care company.

[00:14:00] Tom Cook: There was the FBI, along with our partners at Health & Human Services Office of Inspector General, HHSOIG, had been working an investigation on a doctor here in North Texas named Dr. Laila Hirjee on um, allegations that she was overbilling Medicare for visits and billing for visits that she didn't conduct. As a part of that investigation, we subpoenaed some bank records and were reviewing her financial records, and a company name popped up that had been, that had sent her a significant amount of money every month that was out of context with what the normal industry looks like. At that point, the investigator at the time kind of incorporated some questions about this hospice company.

[00:14:46] Bob: This hospice company, Novus. A doctor, Dr. Hirjee, was getting extravagant payments from Novus, and that led investigators to start asking questions about them. And the answers are alarming.

[00:14:59] Tom Cook: And some of the allegations that came out of those interviews were quite startling. And they prompted us, as well as the OIG to open a separate investigation into Novus to try to corroborate some of that stuff and to see what was really happening at this hospice company.

[00:15:14] Bob: Startling charges like Novus is doing things that put patient care at risk, and worse. The CEO had repeatedly fired off texts to caregivers giving instructions designed to hasten the death of terminally ill patients. At this point, the FBI already had a confidential source, a former employee, but the allegations were so sensational the bureau goes to great lengths to investigate them. So to verify this employee’s these dramatic claims­–they go to Quantico. That’s Tom’s job.

[00:15:46] Tom Cook: The investigator who had the case had sent off a cellphone to our lab at Quantico, Virginia, to try to pull off some of the text messages that would corroborate what a witness was saying. And so, I was the point of contact for the cellphone, um, and then um, uh he also asked me to handle what we call in the FBI, a confidential human source, who would, who was a former employee of the company, who had been reporting on some information on this company.

[00:16:13] Bob: Text messages from that cell phone, and other sources, reveal pretty quickly that CEO Bradley Harris– well, there were troubling patterns in how he runs the company

[00:16:24] Tom Cook: He was a CPA by training, he wasn't a doctor, had no medical training. They would call him Dr. Brad, and he would dictate to the nurses, what kind of medication to give, how much to give it, how often to give it, and there's, there’s a lot to unpack there. He worked at a number of different high-powered accounting firms doing forensic litigation and audit work before he decided to take an entrepreneurial turn and start uh, this hospice company. He had worked for another hospice in North Texas as an administrator and grown the company quite quickly. Had a big breakup with their owner, and then him and some friends from college as well as his girlfriend, and then to be wife, founded Novus. He was laser-focused on protecting himself against any kind of audit, any kind of double-checking of what he was doing. The paranoia of kind of the psychology is, is, was beyond anything I've ever seen and frankly seen since. So the company was run in that way of, we want to make sure that we, we have, that all the paper looks exactly right, so we can't possibly ever get questioned in an audit.

[00:17:35] Bob: In other words, he’s a control freak, and he’s always worried someone might come investigate his firm. And he’s a compulsive texter.

[00:17:45] Tom Cook: It might actually be better to tell you about it through the lens of the people that we talked to. Um, many of the employees, former employees would talk about kind of a PTSD from working for him. Because their phone would ring and ding all day, every day, at all hours of the night. And he was, to send 2000 text messages a day, it's really kind of hard to even conceptualize. But he would send phrase after phrase after phrase after phrase to get, to get to an answer that he wanted. He was quite verbally abusive via text message. And he just, I, I think it was a, a greed and a power issue for him, um, you know, he saw himself as the person in charge, and he wanted it his way. He was a perfectionist. And wanted to make sure he covered all of his tracks.

[00:18:39] Bob: And, he had some bad financial habits

[00:18:43] He was a compulsive gambler, sports, horses, you name it, he was a very big gambler. He would gamble 30, 40, 50 thousand dollars on sports in a weekend. There was a time where two, for lack of a better word, thugs came to the hospice company's front desk to collect a debt. This certainly caused a stir in, you know, well this is not the kind of thing that happens at a medical office, let alone a hospice company.

[00:19:12] Bob: But even worse than the barrage of text messages, the gambling thugs. There are allegations that “Dr. Brad” gave instructions to doctors and nurses designed to hasten the death of patients on Novus care. They would overprescribe morphine, for example. And, he has expressed frustration when that doesn’t work. He once texted to an employee “You need to make this patient go bye-bye,” according to an affidavit obtained by NBC News. After another patient died, he texted a nurse, “nice work,” according to legal documents. But why would a hospice company that gets paid, and paid well, by Medicare want patients to die? The answer lies in the complicated formula that Medicare uses to compensative health care providers for hospice care.

[00:20:00] Tom Cook: Let me, can I give as best I can a summary of how hospice care works. So, hospice is a, a Medicare benefit for anybody in the, anybody who's paid Social Security taxes, and so, the, to qualify for hospice, a doctor has to certify that you have a terminal illness that if it ran its normal course would, you'd have a life expectancy of six months or less. Now Medicare doesn't expect that the doctors have a crystal ball or that they always get it right. There is a lot of flexibility and trust in this, in this system. So, that six-month period is, is important from a general point. So once the doctor has made that determination, the patient is eligible and signed up for hospice care. For this first 90 days, there's no requirement for Medicare that, that a doctor actually sees the patient because Medicare wants to get care to people without a whole lot of burdens. And then the second 90 days is the same thing, Medicare just asks that the doctor certify that this patient is terminally ill, and they, they have a life expectancy of six months or less. Now when it comes to six months, the, the patient has been on two episodes of hospice care, Medicare says, well, um, this patient, the disease didn't run its normal course, or something is going on, so we're, we have an, a requirement that the doctors go visit the patient in person and do an evaluation. And part of that, I think, is a check for fraud, but also it's a check to make sure that the doctor has a good grasp of the patient's medical condition, and that the disease is progressing as they expect, but quite frankly, maybe they'll discover that something has changed and there is a cure or the patient has gotten better or you know, oftentimes we see with chemotherapy, it's really, really hard on the body, and so post an aggressive treatment, people tend to rebound. So Medicare has a requirement that after six months or two episodes of care, to be more precise, that a doctor will visit a patient.

[00:21:58] Bob: So Novus wants as many hospice patients as it can get. But things would become more complicated when patients start living past that 6 month point. It’s important to note that hospice care is governed by what’s called an “aggregate cap” – no one patient living longer than 6 months would trigger an investigation or penalty, it’s an average. So to help keep the average time low – that aggregate cap – Novus aggressively recruited new hospice patients. Too aggressively.

[00:22:30] Tom Cook: So for example, one of the ways that they would try to recruit patients in assisted-living facilities was, Brad was very aggressive about getting durable medical equipment like power wheelchairs and, and things like that. And so he would rely on the word of mouth of patients. So they were telling people, oh, don't worry, just because it's hospice doesn't mean that you're dying. This is a new kind of hospice, and we'll get you, we'll cover your medication. Well, hospice is for folks who have a terminal illness. It's, there, there's no way around that.

[00:23:05] Bob: In other words, Novus recruits patients who don’t need hospice care. As Tom starts looking deeper into Novus, he also starts to understand why doctors like Dr. Hirjee were getting exorbitant payments from Novus. Those three-month and six-month evaluations by a doctor cost Novus money – But Harris has developed a shortcut for that – a profitable shortcut. The CEO just fills out the forms himself, with permission from people like Dr. Mark Gibbs

[00:23:35] Tom Cook: There's some text messages between Dr. Gibbs and Brad, and Brad says he has a couple of recertifications that he needs to get done. And Dr. Gibbs says he could use some cash, could Brad throw in a few more? And then Brad says, "Well," first he says, "Are you kidding?" And then he says, "Well if you give me some blank prescription pads," that he would, that he would then use to, you know, make the medical decisions on his own, he would do it. And, and the text ends with, with a text that says, "If, if we're going to be dirty, I want to be real dirty."

[00:24:11] Bob: "If we're going to be dirty, I want to be real dirty." Wow.

[00:24:16] Tom Cook: Yes.

[00:24:18] And these dirty texts….well, they help explain what Judy was seeing with her mom’s care. But Judy has no idea yet just how bad things were at Novus and for her mom. But when FBI investigators reaches out to Judy the horrible truth starts to emerge.

[00:24:37] Judy Venable: It was so hard, Bob. I mean when I wrote the letter to the Social Security office, I just thought they weren't billing properly. There would have been no way I could have ever imagined he was ordering his nurses to kill the patients. I asked the FBI if Mother was one of those. And I see where one of the patients whose initials were L.V., that's all they would put in writing was the patient was L.V., he was very upset that he, that she had not died. Those are my Mother's initials.

[00:25:13] Bob: Oh my God.

[00:25:15] Judy Venable: Yeah.

[00:25:16] Bob: Oh my God.

[00:25:19] Judy Venable: And I can remember when that happened. Uh Mother had been put on critical care and the nurse came in that night around 11 or 11:30, and I, of course, Mother couldn't breathe. She was unconscious, and I was asking what was going on, and she said, "Your Mother will be dead shortly." Well she didn't die. Uh, I got both of my sons there, and I guess what I did was mess up everything 'cause I did, I wouldn't leave the room, but um, that nurse was relieved by another nurse who came in and said, "Your Mother's fine. She's going to be okay." So...

[00:25:56] Bob: Oh my God.

[00:25:57] Judy Venable: That, that particular scenario plays in my mind a lot if that was when she was supposed to have died.

[00:26:04] Judy’s mom, and many other Novus patients, were supposed to die. Armed with thousands of incriminating text messages – messages that even express frustration that Judy’s mom didn’t die – what will the FBI due to stop Novus Health Care and CEO Bradley Harris? And what happens to Judy’s mom? That’s next week on The Perfect Scam

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[00:26:40] Bob: If you have been targeted by a scam or fraud, you are not alone. Call the AARP Fraud Watch Network Helpline at 877-908-3360. Their trained fraud specialists can provide you with free support and guidance on what to do next. Thank you to our team of scambusters; Associate Producer, Annalea Embree; Researcher, Sarah Binney; Executive Producer, Julie Getz; and our Audio Engineer and Sound Designer, Julio Gonzalez. Be sure to find us on Apple Podcasts, Spotify, or wherever you listen to podcasts. For AARP's The Perfect Scam, I'm Bob Sullivan.

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