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A Texas doc stole $16M from Medicare with a kickback scheme involving multiple home health agencies and patients who agreed to say that got home health services that were never provided.
A gavel (WDIV)
HOUSTON – A Texas physician was sentenced to five years in prison Wednesday for a $16 million Medicare fraud scheme, federal officials said.
Yolanda Hamilton, M.D., 57, of Harris County, 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. Hamilton is ordered to pay $9.5 million in restitution.
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.
Authorities said from January 2012 to August 2016, Hamilton conspired with others to defraud Medicare by signing false and fraudulent home health care paperwork that was used to submit fraudulent claims to Medicare, according to a news release about the sentencing.
Federal authorities said in a news release that Hamilton and her co-conspirators made it appear that the patients qualified and received home health care services, when they often did not. Members of the conspiracy paid the patients to receive the home health care services, which were often medically unnecessary, not provided, or both, the news release said. The evidence also showed that Hamilton required home health care 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, according to the news release about the sentencing.
Hamilton typically would not release the home health care paperwork until the home health care companies or their marketers paid her the kickback, authorities said, citing evidence from the case.
Federal authorities said 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.
To date, the Department of Justice said in its news release that several “co-conspirators” including 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.