Texas Physician Convicted for $16M Medicare Scheme

Ken Terry

October 10, 2019

A federal court jury in Texas found Yolanda Hamilton, MD, guilty of participating in a $16 million Medicare fraud scheme in which she signed false plans of care and other medical documents related to purported home health services.

Following a 6-day trial, Hamilton, 56, the owner and operator of HMS Health and Wellness Center in Houston, was convicted of one count of conspiracy to commit healthcare fraud, one count of conspiracy to solicit and receive healthcare kickbacks, and two counts of false statements related to healthcare matters.

Hamilton ― who specializes in gastroenterology and internal medicine ― is expected to be sentenced before US District Judge Keith P. Ellison of the Southern District of Texas, who presided over the trial. A sentencing date has not been set yet.

Hamilton's co-conspirators in the fraud scheme, who were not named in a Department of Justice news release or in the indictment against her, evidently included owners of at least four home health agencies (HHAs) and the patient marketers they worked with.

Between January 2012 and August 2016, according to the news release and the indictment, Hamilton saw Medicare patients referred to her by the HHAs and certified or recertified home health services for them.

She signed plans of care that made it appear that these patients needed home health services even if those services were not medically necessary, not provided, or both. She also ordered medically unnecessary tests for some patients.

Patient Recruiters

Hamilton charged a $60 fee for each home health certification. Although she claimed this was a patient copay, the evidence shows that she knew that the HHAs frequently paid the fee, the news release said. Therefore, she was charged with making illegal kickbacks for referrals to the home care agencies.

According to the indictment, the HHAs worked with patient recruiters or marketers who directed Medicare beneficiaries and dual Medicare/Medicaid beneficiaries to visit HMS Health and Wellness Center to be certified and recertified for home health services.

"The owners of HHAs, as well as the marketers working with them, often paid patients to sign up, and remain with, an HHA for purported home-health services," the indictment stated.

During the 4-year period, Hamilton submitted $2.8 million in Part B claims to Medicare for certifying and recertifying the patients for home care. Medicare paid her $275,000 on those claims. The HHAs submitted $13.8 million in home health service claims on which Hamilton was listed as the attending physician.

Before starting her practice, Hamilton was an assistant professor at MD Anderson Cancer Center and later at the University of Texas Health Sciences Center, according to the biography on her website.

Hamilton's practice did not respond to a request for comment.

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