Texas physician guilty of bilking Medicare $16M in home health fraud scheme

Medical justice
A Texas jury found a Houston-based physician guilty of a $16 million scheme to defraud Medicare. (Getty/yavdat)

A federal jury ruled a Texas physician was guilty of a $16 million scheme to defraud Medicare by signing false “plans of care” for home health services.

Yolanda Hamilton, 56, the owner and operator of HMS Health and Wellness Center, was found guilty on Monday on one count of conspiracy to commit healthcare fraud, one count of conspiracy to solicit and receive healthcare kickbacks and two other counts of false statements on healthcare matters.

From 2012 to 2016, Hamilton and others submitted false claims to Medicare that made it appear her patients and co-conspirators needed home health services, according to the Department of Justice.

“In fact, Hamilton and her co-conspirators paid the patients to sign up and recertify their home health services when those services were often not medically necessary, not provided or both,” the DOJ said in a release. “The evidence also showed that Hamilton charged home health agencies an illegal kickback in the form of a patient ‘fee’ for certifying and recertifying patients for home-health services that the home health agencies, not the patients, would pay.”

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All told, the scheme netted Hamilton and her co-conspirators approximately $16 million in claims from Medicare.

So far, others have pleaded guilty or were found guilty at trial for their roles in the scheme and several more have been charged, DOJ said.

The guilty verdict comes roughly a month after the CEO of San Francisco-based Amity Home Health and 28 healthcare workers were charged in an alleged patients-for-cash kickback scheme. DOJ charged that the agency paid kickbacks to marketers, doctors and other professionals for referrals of patients for home health and hospice services, a release said.

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Fraud has always plagued the Medicare program, which is one of the biggest government payers.

The Centers for Medicare & Medicaid Services released a final rule last month that gives the agency more power to tackle fraud. The rule enables CMS to revoke or deny an organization from participating in a government program if that organization is associated with a previously sanctioned individual or group.