Monday, November 30, 2020

Texas physician gets five years for role in Medicare fraud scheme

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A Texas physician was sentenced to five years in prison today for her role in a multi-million Medicare fraud scheme.

Yolanda Hamilton, M.D., 57, of Harris County, Texas, the physician-owner and operator of HMS Health and Wellness Center, PLLC, was sentenced by U.S. District Judge Keith P. Ellison of the Southern District of Texas.  Judge Ellison also ordered the defendant to pay $9.5 million in restitution.

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Hamilton was convicted by a federal jury of one count of conspiracy to commit health care fraud, one count of conspiracy to solicit and receive health care kickbacks, and two counts of false statements relating to health care matters in October 2019.  According to the evidence presented at trial, from January 2012 to August 2016, Hamilton conspired with others to defraud Medicare by signing false and fraudulent home healthcare paperwork that was used to submit fraudulent claims to Medicare.

Hamilton and her co-conspirators made it appear that the patients qualified and received home healthcare services, when they often did not.  In fact, members of the conspiracy paid the patients to receive the home healthcare services, which were often medically unnecessary, not provided, or both.  The evidence also showed that Hamilton required home healthcare agencies to pay an illegal kickback, which Hamilton disguised as a “co-pay,” in exchange for Hamilton certifying and recertifying patients for home healthcare services.

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Hamilton typically would not release the home healthcare paperwork until the home healthcare companies or their marketers paid her the kickback, the evidence showed.  The scheme resulted in approximately millions in false and fraudulent claims for home-health services to Medicare and in Hamilton receiving over $300,000 in kickbacks.

All defendants are presumed innocent until convicted beyond a reasonable doubt in a court of law.

To date, several co-conspirators incuding marketers, patient recruiters along with doctors, and nurses who purchased plans of care and other signed medical documents from Hamilton have been charged, found guilty, or pleaded guilty to conspiracy to commit health care fraud and/or paying or receiving kickbacks.

The FBI, HHS-OIG, and MFCU investigated the case, which was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Texas.  Trial Attorneys Catherine Wagner, Thomas Tynan, and Carlos Lopez of the Fraud Section prosecuted the case.  Trial Attorney Scott Armstrong indicted the case.

The Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 15 strike forces operating in 24 districts, has charged more than 4,200 defendants who have collectively billed the Medicare program for nearly $19 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Acting Assistant Attorney General Brian C. Rabbitt of the Justice Department’s Criminal Division, U.S. Attorney Ryan K. Patrick of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office, Special Agent in Charge Miranda Bennett of the U.S. Department of Health and Human Services Office of the Inspector General’s (HHS-OIG) Dallas Regional Office, and the Texas Attorney General’s Medicaid Fraud Control Unit (MFCU) made the announcement.

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