Greedy Gastroenterologist

Shot of two doctors working together on a digital tablet in a hospital

The average U.S. per capita income in 2016 was $57,617 according to the Census; meanwhile, gastroenterologists earned an average of $380,000, per the Medscape Gastroenterologist Compensation Report 2016. Greed is a powerful thing, driving a Texas physician—who presumably earned better than six times a typical family income— to participate in a massive Medicare fraud scheme that would ultimately destroy her professional reputation and threaten her freedom. (Being poor doesn’t excuse fraud; being affluent does make it doubly deplorable.)

Yolanda Hamilton, M.D., who owned and operated a Houston medical clinic, conspired with other health professionals to file Medicare claims for home health services that were unneeded and/or not delivered. The group racked up $16 million in fraudulent claims through the scam in less than four years. Hamilton charged home health agencies kickbacks to certify or recertify patients for the services. Hamilton and her co-conspirators also paid the patients to sign up for home health services.

The FBI and Department of Health and Human Services (HHS) investigated the case as part of the Medicare Fraud Strike Force. Hamilton was convicted in October 2019 of conspiracy to commit health care fraud, conspiracy to solicit and receive health care kickbacks, and two counts of false statements relating to health care matters. Her sentencing is pending. Just for the kickbacks, Hamiliton may face fines and penalties, a jail term, and being excluded from participating in federal health care programs. Meanwhile, several of her Texas partners in Medicare fraud have been found guilty or pleaded guilty to conspiracy and/or paying or receiving kickbacks. (Let’s hope they all get massive fines and ample prison time to contemplate the error of their ways.)

Today’s Fraud of the Day comes from a Department of Justice news release, “Texas Physician Convicted in $16 Million Medicare Fraud Scheme,” published Oct. 7, 2019.

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.

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Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.