A federal judge sentenced two physicians in the Novus Healthcare Services hospice fraud case to 23 years and prison and ordered them to pay more than $44 million in restitution. A nurse who was also part of the $40 million fraud case was sentenced to 33 months in federal prison.
The familiar scheme involved illegally admitting patients who were not appropriate for hospice while submitting false claims for services provided. Novus- a Frisco-based hospice provider, was one of the largest in the state before it closed in 2015. An increasing elderly population and an overburdened federal healthcare system make the industry vulnerable to fraud.
Estimates range that fraud accounts for somewhere between 3 to 10 percent of all healthcare spending. In 2020, the Centers for Medicare and Medicaid found that more than 6 percent, or upwards of $25 billion, were improper healthcare payments made by the federal government. In 2020, the Department of Justice prosecuted more healthcare fraud cases than ever. Of the 900 matters opened by the department, 580 were health fraud, most falling under the false claims act. The DOJ settled a record 256 False Claims Act studies in 2020, more than any other year.