I read this story in a news feed in the Dallas Morning News by justice system reporter Jennifer Emily last week and I just had to comment about the story. This story was first reported in February of 2017 as individuals were indicted in the case. Criminal indictments had been returned against the owners of the one of the largest hospice providers in North Texas, Novus Health Services and Optim Health Services Inc*., doctors associated with the companies, and executives at the companies for what amounts to Medicare fraud. More shocking is the length to which the defendants allegedly went to commit the $60 million dollar Medicare fraud scheme which may have included hastening the deaths of residents according to a company executive that just plead guilty in the case.

A company executive, Melanie Murphy, plead guilty to Medicare fraud. Court records allege that the owner of Novus actually hastened or contributed to the deaths of patients being treated by Novus when those patient’s Medicare eligibility for enhanced palliative care was exhausted. If true, it is a bombshell. In criminal law they call it murder or potentially multiple murders for cold hard cash. The fact that this type of alleged wrongdoing was uncovered at all is likely a testament to the civil justice system and a little know anti-corruption federal law that empowers federal prosecutors.

Reading between the lines of the stories, it looks like a classic qui tam case to uncover the initial billing wrongdoing and tip off federal law enforcement that potential criminal action was afoot. Federal law allows a person with knowledge of a fraud on the federal government, any governmental contractor including medical contractor, to blow the whistle on the wrongdoing and actually receive a percentage of the recovery back to the federal government. To qualify the person with knowledge of the fraud hires a lawyer and files a federal lawsuit under seal, together with evidence supporting the claim. The first person to file the qui tam action is eligible for the fee as long as all of the stringent legal requirements are met. Thereafter, the appropriate federal law enforcement agency, investigates the case and the United States Attorney decides whether to intervene in the case and when to intervene. Frequently, when wrongdoing is verified, criminal cases follow even before the qui tam action is allowed to go forward to a civil trial. The person bringing the qui tam case has federal protection from retaliation for bringing the case as well.

At my firm we can and have handled qui tam actions that have returned a lot of taxpayer’s money from the hands of corporate criminals back to the federal government. I suspect, but do not know for sure, that a similar qui tam action is the genesis of the investigation. I mention this because it shows the value of the civil justice system in exposing wrongs to the light of day in situations that prosecutors and law enforcement may not ever discover without private lawyers acting as a private attorney general and exposing the criminal conduct. While many corporate interests like to demonize private lawyers for bringing lawsuits against businesses, this case shows exactly why it is needed to enhance the safety of the most vulnerable among us. Whoever filed this case likely thought that they were only prosecuting a financial fraud. In the end it may have exposed murder, it may have prevented future injury or death to the elderly, and certainly provides an object lesson for those in the palliative care industry not to defraud the government and to treat those at the end of their lives with care and dignity.

There have been attempts over several legislative sessions to adopt a similar law in our state when the state is defrauded. Thus far, the attempts have gone no where due to business opposition. We can hope that stories like this one will show the leaders of our great state the benefits to our citizens and to the state of adopting a similar qui tam law.

* I inadvertently misspelled the name of the company in the original blog post and wanted to clarify that the company criminally indicted was Optim Health Services, Inc. and not Optum Health Services, Inc. which has not been accused of any wrongdoing in this case.