Bevy of Fraudsters

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Stethoscope on 100 dollar bills symbolizing financial surveillance

Medicare reimburses for legitimate home healthcare services delivered by medical providers. Because home healthcare is provided in a patient’s own home, this less expensive, more convenient service is considered just as effective as the care provided in a hospital or skilled nursing facility. Leave it to Dr. Yolanda Hamilton, the owner and operator of HMS Health and Wellness Center in Houston, Tex., to mess up a good thing. She exploited her patients and the Medicare program by billing for $16 million of home healthcare services that were either not medically necessary, never rendered, or both.

Dr. Hamilton describes her medical philosophy as “providing quality care with compassion” on her company website. Also interesting is the practice’s mission: To improve the longevity, health, and quality of life for our patients. (Perhaps a more fitting mission statement would be to: Improve Dr. Hamilton’s own longevity, health, and quality of life through a huge bank account funded by unsuspecting taxpayers.)

As you might guess, Dr. Hamilton did not pull off this $16 million Medicare fraud scam on her own. She and a multitude of co-conspirators filled out false home healthcare paperwork that was used to submit many fraudulent claims stating patients both qualified for and received home healthcare services. (That was simply not the case.) 

According to federal authorities, the conspiratorial clan paid patients to receive the home healthcare services, which were often medically unnecessary, not provided, or both. The doctor even went as far as to require home healthcare agencies to pay kickbacks, disguised as co-pays, for certifying patients for these unneeded services. (She was a tough negotiator. The doctor refused to release the paperwork until she had received her kickback.)

The Harris County doctor was convicted of one count each of conspiracy to commit healthcare fraud and conspiracy to solicit and receive healthcare kickbacks, and two counts of making false statements on healthcare matters. She was sentenced to a five-year prison term for committing $16 million in Medicare fraud. Hamilton was also ordered to pay $9.5 million in restitution.

So far, a bevy of healthcare professionals (more like professional fraudsters), including fellow doctors, nurses and patient recruiters have either been found guilty or pleaded guilty to conspiracy to commit health care fraud, getting kickbacks—or both.

Today’s Fraud of the Day comes from an article, “Harris County doctor sentenced in $16M Medicare fraud scheme, authorities say,” published by Click2Houston.com on November 19, 2020.

ATLANTA – Diandra Bankhead, the owner and operator of Elite Homecare (“Elite”), an Atlanta-based home healthcare provider, has been sentenced for defrauding Medicaid out of nearly $1 million. Between September 2015 and April 2018, Bankhead submitted thousands of fraudulent claims for services that were never provided to medically fragile children under the Georgia Pediatric Program (“GAPP”).

“It is outrageous that Bankhead profited off children who suffered from significant physical and cognitive disabilities,” said U.S. Attorney Byung J. “BJay” Pak. “For years her scheme exploited Medicaid-eligible children and their families by billing for services never performed and for children never seen, diverting critical resources from those who needed them most.”

 

 

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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.