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Physician ordered to pay $9.5 million in restitution in home health fraud case

Shidonna Raven Garden and Cook

November 23, 2020
Joe Jancsurak

A Texas physician has been sentenced to five years in prison and ordered to pay $9.5 million in restitution for her role in a multi-million Medicare fraud scheme, according to the Department of Justice.

Yolanda Hamilton, M.D., was convicted of making it appear that patients qualified and received home healthcare services, when often they did not. Others reportedly involved in the scheme allegedly paid patients to receive home healthcare services, which often were medically unnecessary, not provided, or both.  

The evidence, according to the Justice Department, also showed that Hamilton required home healthcare agencies to pay an illegal kickback, which the physician disguised as a co-pay, in exchange for her certifying and recertifying patients for home healthcare services. 

Hamilton was convicted of one count of conspiracy to commit healthcare fraud, one count of conspiracy to solicit and receive healthcare kickbacks, and two counts of false statements relating to healthcare matters.

Would you recognize health care fraud if you saw it? What would it look like? What should be done?

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