Texas Physician Found Guilty of $16M Home Health Scheme; Pennsylvania Provider Accused of ‘Sham Staffing’

A Texas-based physician has been found guilty for taking part in a $16 million Medicare scheme.

On Oct. 7, the U.S. Department of Justice (DOJ) announced that, after a six-day trial, Dr. Yolanda Hamilton was convicted of a single count of conspiracy to commit health care fraud and conspiracy to solicit and receive health care kickbacks. Hamilton was also convicted of two counts of false statements relating to health care matters.

Hamilton is the owner and operator of Houston, Texas-based HMS Health and Wellness Center PLLC.

In a scheme that took place from January 2012 to August 2016, Hamilton and her co-conspirators allegedly signed fraudulent plans of care and other medical documents while submitting fraudulent claims for home health services to Medicare. Patients were paid to sign-up and recertify for home health services that were either medically unnecessary or, in some cases, not provided.

According to trial evidence, Hamilton charged home health agencies an illegal patient fee — a kickback — for certifying and recertifying patients for these services.

In total, the scheme amassed $16 million in false and fraudulent claims for home health services to Medicare, making it one of the biggest single cases in recent memory.

Hamilton will be sentenced before U.S. District Judge Keith P. Ellison of the Southern District of Texas, who presided over the trial, at a time that has not been set yet.

In other legal news, DOL is cracking down on a Pennsylvania-based home health company and its CEO for supposed overtime and recordkeeping violations.

Toni Chandler Duncan, the CEO and owner of Heart 2 Heart LLC, was sued by DOL for alleged overtime, recordkeeping and employee classification violations under the Fair Labor Standards Act (FLSA).

DOL officials claimed that Duncan used sham staffing agencies for the purpose of misclassifying workers, intentionally included false information in payroll records and failed to pay employees the statutory minimum rate for hours worked.

The department further alleged that Duncan misclassified employees as independent contractors, according to court documents.

Founded in 2012, Pittsburgh-based Heart 2 Heart provides care for adults with intellectual or physical disabilities, in addition to direct care services to seniors and clients who are homebound.

The U.S. District Court for the Western District of Pennsylvania found that Duncan violated the FLSA’s overtime and recordkeeping provisions. The court ruled that Heart 2 Heart workers were not independent contractors but employees.

Under the FLSA, an employment relationship is determined through the economic realities test, which includes: the degree of control the employers have over the work, the opportunity for profit or loss depending upon an employees managerial skill, the employee’s investment in equipment or materials required for work, whether their service requires special skills and whether the service is an integral part of the employer’s business.