Texas Physician Sentenced for Multi-Million Medicare Fraud Scheme

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

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.

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.

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. 

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.

The year 2020 marks the 150th anniversary of the Department of Justice. Learn more about the history of our agency at www.Justice.gov/Celebrating150Years.

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    In U.S GAO News
    The Venezuelan economy's performance has declined steadily for almost a decade and fallen steeply since the imposition of a series of U.S. sanctions starting in 2015. For example, the economy declined from negative 6.2 percent gross domestic product growth in 2015 to negative 35 percent in 2019 and negative 25 percent in 2020. The sanctions, particularly on the state oil company in 2019, likely contributed to the steeper decline of the Venezuelan economy, primarily by limiting revenue from oil production. However, mismanagement of Venezuela's state oil company and decreasing oil prices are among other factors that have also affected the economy's performance during this period. U.S. agencies have sought input from humanitarian organizations to identify the potential negative humanitarian consequences of sanctions related to Venezuela and taken steps to mitigate these issues. The U.S. Agency for International Development (USAID) and Department of State (State) have solicited input from U.S.-funded humanitarian organizations on challenges they face, including the impact of sanctions. The U.S. Department of the Treasury (Treasury) and State have also taken steps to mitigate negative consequences. For example, Treasury issued licenses permitting various types of humanitarian assistance transactions in Venezuela (see figure). Treasury also maintains a call center and email account through which organizations can receive assistance with compliance issues or other challenges related to sanctions. While Treasury officials told GAO they respond to individual inquiries, Treasury does not systematically track and analyze information from these inquiries to identify trends or recurrent issues. Without collection and analysis of this information, Treasury and its interagency partners may be limited in their ability to develop further actions to ensure that U.S. sanctions do not disrupt humanitarian assistance. U.S. Humanitarian Assistance Supplies for Venezuelans U.S. sanctions related to Venezuela have likely had a limited impact, if any, on the U.S. oil industry. Despite an overall lower supply of oil in the U.S. market from the loss of Venezuelan crude oil due to sanctions, crude oil and retail gasoline prices in the U.S. have not increased substantially. Many other factors in addition to the sanctions simultaneously affected the oil market and the price of crude oil and retail gasoline prices, including production cuts in January 2019 by the Organization of the Petroleum Exporting Countries and decreased demand for energy during the COVID-19 pandemic. According to industry officials to whom GAO spoke, U.S. refineries have adjusted to these changes by shifting to alternative sources and types of crude oil. Venezuela has been experiencing an economic, political, and humanitarian crisis. The U.S. government has imposed sanctions on Venezuela's state oil company, government, and central bank, among others, in response to activities of the Venezuelan government and certain individuals. Treasury and the Department of State lead the implementation of the sanctions program, and USAID is primarily responsible for implementing humanitarian assistance for Venezuelans. GAO was asked to review U.S. sanctions related to Venezuela. This report examines: (1) how the Venezuelan economy performed before and since the imposition of sanctions in 2015; (2) the steps U.S. agencies have taken to identify and mitigate potential negative humanitarian consequences of sanctions related to Venezuela; and (3) what is known about the impact of U.S. sanctions related to Venezuela on the U.S. oil industry. GAO analyzed economic indicators, reviewed documents, interviewed agency officials, and spoke with representatives from selected humanitarian organizations and the U.S oil industry. GAO recommends that Treasury systematically track inquiries made to its call center and email account, including the specific sanctions program and the subject matter of the inquiry to identify trends and recurring issues. Treasury concurred with GAO's recommendation. For more information, contact Kimberly Gianopoulos at (202) 512-8612 or GianopoulosK@gao.gov.
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  • Justice Department Requires Divestiture of Tufts Health Freedom Plan in Order for Harvard Pilgrim and Health Plan Holdings to Proceed With Merger
    In Crime News
    The Department of Justice announced today that it would require Harvard Pilgrim Health Care (Harvard Pilgrim) and Health Plan Holdings (fka Tufts Health Plan) to divest Tufts Health Freedom Plan Inc. (Tufts Freedom), in order to proceed with their merger. Tufts Freedom is Health Plan Holdings’ commercial health insurance business in New Hampshire. The department has approved UnitedHealth Group Inc. (United), as the buyer. Health insurance is an integral part of the American healthcare system, and the proposed settlement will maintain competition for the sale of commercial health insurance to private employers in New Hampshire with fewer than 100 employees.
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  • National Freedom Day: Deepening Our Resolve to Fight Human Trafficking
    In Crime Control and Security News
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  • Indian Education: Schools Need More Assistance to Provide Distance Learning
    In U.S GAO News
    What GAO Found The Bureau of Indian Education (BIE), within the Department of the Interior (Interior), has not provided BIE-funded schools with comprehensive guidance on distance learning during the COVID-19 pandemic. In March 2020, BIE issued a short memo directing schools to “deliver flexible instruction” and “teach content,” but did not offer specific guidance on how to do so. In July 2020, 13 of the 25 schools that responded to GAO's survey said they wanted BIE to provide information on developing and implementing distance learning programs. In addition, 12 schools responded that they wanted information on distance learning methods for areas without broadband internet access. In August 2020, after some schools had already begun the school year, BIE issued a re-opening guide for the 2020-2021 school year. BIE's guidance focused primarily on preparations for in-person instruction at schools, although nearly all schools provided distance learning during the fall of 2020. The guidance contained little information on distance learning. Providing schools with comprehensive distance learning guidance will help them better navigate the current pandemic as well as potential future emergencies that lead to school building closures. BIE helped improve internet access for students at BIE-operated schools during the pandemic, but many students had not received laptops to access online learning by the end of fall 2020. BIE and other Interior offices provided over 7,000 hotspots to students to improve home internet access, but they did not order laptops for most students until September 2020. Interior officials said a nationwide IT supply shortage contributed to the delayed order for about 10,000 laptops. GAO found, however, that delays were also caused in part by BIE not having complete and accurate information on schools' IT needs. Most schools received laptops from late October 2020 to early January 2021, although some laptops still had not been delivered as of late March 2021. Once laptops were delivered, however, schools also faced challenges configuring them, leading to further delays in distributing them to students. BIE officials told GAO that to address schools' challenges with configuring laptops, they are assessing schools' IT workforce needs. Most BIE students did not receive laptops until months after the school year began, according to GAO's analysis of Interior information. Specifically, none of the laptops Interior ordered in early September 2020 arrived in time to distribute to students by the start of the school year in mid-September; by the end of December 2020, schools had not distributed over 80 percent of the student laptops Interior ordered; and as of late March 2021, schools had not distributed about 20 percent of the student laptops Interior ordered. Without accurate, complete, and up-to-date information on schools' IT needs, BIE was unable to ensure that students received laptops when they needed them. Establishing policies and procedures for assessing schools' IT needs would help guide the agency's IT purchases now and in the future, and position schools to integrate technology into their everyday curricula. Why GAO Did This Study BIE's mission is to provide quality education to approximately 41,000 students at 183 schools it funds on or near Indian reservations in 23 states. About two-thirds of these schools are operated by tribes and the remaining third are operated by BIE. In March 2020, all BIE schools closed their buildings in response to the COVID-19 pandemic. GAO reviewed distance learning at BIE schools as part of its oversight responsibilities under the CARES Act. This testimony examines the extent to which (1) BIE has provided schools with guidance to develop and implement distance learning programs during the COVID-19 pandemic, and (2) students have had the technology they need to participate in such programs. GAO analyzed the guidance BIE provided to schools on distance learning, examined BIE's provision of technology to schools and students, surveyed a non-generalizable sample of 30 schools—including 19 operated by tribes and 11 operated by BIE— with 25 schools responding, selected for geographic diversity and level of community broadband access, among other criteria, reviewed relevant federal statutes, regulations, and agency documentation, and interviewed BIE and school officials.
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  • Grand Juries Carry on During Pandemic
    In U.S Courts
    As the federal courts have gradually resumed operations with new pandemic-era health and safety rules in place, one aspect of the courts’ mission is on a fast track: the resumption of grand jury proceedings.
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  • New Jersey Man Pleads Guilty to Violating the Foreign Corrupt Practices Act
    In Crime News
    A New Jersey man who controlled two U.S.-based companies pleaded guilty today for paying a total of $100,000 in bribes to a Korean government official in order to obtain and retain contracts with the Defense Acquisition Program Administration (DAPA), a state-owned and state-controlled agency within the Republic of Korea’s Ministry of National Defense.
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