Yolanda Hamilton, the physician-owner and operator of HMS Health and Wellness Center, PLLC in Texas, has been sentenced to five years in prison for leading a multi-million dollar Medicare fraud scheme.

According to the Department of Justice (DOJ), a federal jury found Hamilton guilty 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."

The DOJ alleged that Hamilton ran the Medicare fraud scheme from Jan. 2012 to Aug. 2016. She conspired with other individuals to defraud Medicare by submitting and signing fraudulent home healthcare paperwork in order to submit fake claims.

In total, Hamilton defrauded Medicare of millions of dollars in false claims and received over $300,000 in kickbacks. The DOJ also alleged that Hamilton and her co-conspirators convinced patients that they were eligible for home healthcare services that were medically unnecessary nor approved. Hamilton then required home healthcare agencies to pay a 'co-pay,' which in reality was a kickback.

Evidence showed Hamilton would often not release crucial home healthcare paperwork until a kickback was received, effectively blackmailing providers. The DOJ confirmed that she had multiple co-conspirators, including doctors, patient recruiters, and marketers as well as nurses. In many cases, these individuals have "been charged, found guilty, or pleaded guilty to conspiracy to commit health care fraud and/or paying or receiving kickbacks."

While it is unknown what sentences co-conspirators received, it has been confirmed that Hamilton was convicted of the aforementioned crimes and sentenced to five years in prison.

Sadly, healthcare fraud is far from a new crime and has been a consistent issue for a number of years. The biggest losers in schemes of this kind are of course the patients who depend on care providers to give them accurate information about treatment options, eligible services and etc.

Hamilton's egregious actions used that trust to pilfer millions of dollars from the U.S. healthcare system, a crime that appears to not have gone unpunished. In this case, justice has indeed been served.

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