Texas Physician Convicted in $16 Million Medicare Fraud Scheme

A federal jury in Texas found a physician who was the owner and operator of a medical clinic in Houston, Texas, guilty today of participating in a $16 million Medicare fraud scheme in which she signed false and fraudulent “plans of care” and other medical documents for purported home health services.

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ryan Patrick of the Southern District of Texas, Special Agent in Charge Perrye K. Turner of the FBI’s Houston Field Office and Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of the Inspector General’s (HHS-OIG) Dallas Regional Office made the announcement.

Following a six-day trial, Yolanda Hamilton, M.D., 56, of Harris County, Texas, the owner and operator of HMS Health and Wellness Center, PLLC, was convicted 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.  Hamilton is expected to be sentenced before U.S. District Judge Keith P. Ellison of the Southern District of Texas, who presided over the trial.  A sentencing date has not yet been set.

According to the evidence presented at trial, from January 2012 to August 2016, Hamilton and others conspired to defraud Medicare by signing false and fraudulent plans of care and other medical documents, and submitting fraudulent claims to Medicare to make it falsely appear that the patients of Hamilton and her co-conspirators qualified and received home-health services under Medicare.  In fact, Hamilton and her co-conspirators paid the patients to sign-up and recertify for home health services when those services were often not medically necessary, not provided or both.  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.  The scheme resulted in approximately $16 million in false and fraudulent claims for home-health services to Medicare, the evidence showed. 

To date, several others have pleaded guilty or been found guilty at trial based on their roles in a larger fraudulent scheme that included Hamilton.  Several others 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 pay or receive kickbacks. 

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

The FBI and HHS 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 are prosecuting 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 almost $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.