United States v. Hamilton
| Decision Date | 15 June 2022 |
| Docket Number | 20-20645 |
| Parties | UNITED STATES of America, Plaintiff—Appellee, v. Yolanda HAMILTON, Medical Doctor, Defendant—Appellant. |
| Court | U.S. Court of Appeals — Fifth Circuit |
Andrew C. Noll, U.S. Department of Justice, Criminal Division, Appellate Section, Washington, DC, Jeremy Raymond Sanders, Trial Attorney, U.S. Department of Justice, Criminal Division Fraud Section, Washington, DC, Carmen Castillo Mitchell, Assistant U.S. Attorney, U.S. Attorney's Office, Southern District of Texas, Houston, TX, for Plaintiff-Appellee.
Marcy Hogan Greer, Anna M. Baker, Alexander Dubose & Jefferson, L.L.P., Austin, TX, Anna M. Baker, Holland & Knight, L.L.P., Houston, TX, for Defendant-Appellant.
Before Higginson, Willett, and Ho, Circuit Judges.
A jury convicted Dr. Yolanda Hamilton of conspiracy to commit healthcare fraud, in violation of 18 U.S.C. § 1349 ; conspiracy to solicit and receive healthcare kickbacks, in violation of 18 U.S.C. § 371 ; and two counts of false statements relating to healthcare matters, in violation of 18 U.S.C. § 1035. On appeal, Dr. Hamilton challenges both her conviction and sentence. For the following reasons, we AFFIRM.
Dr. Hamilton, a licensed physician, owned and operated HMS Health and Wellness Center in Houston, Texas and was the sole physician at her clinic. Around June 2012, Dr. Hamilton enrolled as a Medicare provider. In addition to providing primary care and gastroenterology services, Dr. Hamilton certified Medicare patients for home healthcare.
The relevant background on Medicare processes related to home healthcare was helpfully summarized in United States v. Ganji , 880 F.3d 760 (5th Cir. 2018) :
Home health care services are those skilled nursing or therapy services provided to individuals who have difficulty leaving the home without assistance.... The process for receiving home health care services begins when a physician identifies a patient as an eligible candidate.... Then a nurse goes to the patient's home to assess if she is homebound, completing an Outcome and Assessment Information Set ("OASIS"). The nurse then develops a plan of care based on the OASIS and forwards that document [known as Form 485] to a physician for approval.... In 2011, Medicare implemented a face-to-face requirement to further ensure that medical professionals would not order home health care without ever seeing the patient. This required medical professionals to actually see the patient for the initial meeting, but "[t]he face-to-face patient encounter may occur through telehealth in person." [ 42 C.F.R. 424.22(a)(1)(v)(B).] Regulations allow for medical professionals who are not physicians to complete the face-to-face encounter, but the professionals have to be under the supervision of a physician. A medical professional certifies that they completed this encounter by completing a face-to-face addendum. The agency then sends the addendum with the Form 485 certification forms, which were used to certify patients for home health care to Medicare for reimbursement. If the professional determines the patient is homebound [and signs the Form 485], the agency staff immediately provides that care.
A physician signing a Form 485 (and thus certifying a patient for home healthcare) must attest that the patient is confined to the home ("homebound"). 42 C.F.R. § 424.22(a)(1)(ii). An individual is confined to the home if (1) "the individual has a condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive device (such as crutches, a cane, a wheelchair, or a walker)," or "if the individual has a condition such that leaving his or her home is medically contraindicated," and (2) "there exists a normal inability to leave home and that leaving home requires a considerable and taxing effort by the individual." 18 U.S.C. § 1395n(a) (emphasis added). The initial certification lasts 60 days, after which time the physician must recertify the patient. 42 C.F.R. § 424.22(b).
For some patients that Dr. Hamilton certified, she conducted the required face-to-face encounter herself at her clinic. For others, a nurse practitioner conducted the face-to-face encounter at the patient's home. When the patient was seen by Dr. Hamilton at her clinic, Dr. Hamilton charged a $60 fee. This fee was typically paid by representatives of the home healthcare agencies ("HHAs") to whom she was certifying patients, but at least on some occasions, the fee was paid by the patients themselves. After a period of time, Dr. Hamilton instituted a policy that the Form 485, the certification that the HHAs needed in order to bill Medicare for home healthcare services, see 42 C.F.R. § 424.22(a)(1), would not be released to the HHAs until the $60 fee was paid.
Simultaneously, some HHAs in Houston were paying individuals known as "marketers" or "recruiters" to recruit Medicare beneficiaries for home healthcare. Recruiters then paid the patients they recruited in exchange for their getting certified to receive home healthcare. HHAs often falsified information in the OASIS and Form 485s that they submitted to physicians for certification in order to ensure the physician certified the patients for home healthcare.
In November 2015, the FBI executed a search warrant at HMS, Dr. Hamilton's clinic. A grand jury later charged Dr. Hamilton with one count of conspiracy to commit healthcare fraud, in violation of 18 U.S.C. § 1349 ; one count of conspiracy to solicit and receive kickbacks, in violation of 18 U.S.C. § 371 ; and four counts of making false statements relating to healthcare matters, in violation of 18 U.S.C. § 1035. The Government alleged that Dr. Hamilton participated in a conspiracy to commit healthcare fraud with the HHAs by certifying patients for home healthcare when she knew they were not homebound as defined by Medicare. Further, the Government alleged that the $60 payments that Dr. Hamilton demanded before she would release the certifications to the HHAs were illegal kickbacks. The substantive counts of making false statements were tied to Dr. Hamilton's certification of four individual patients for home healthcare.
Dr. Hamilton was first tried in May 2019. After a six-day trial, the jury was unable to reach a unanimous verdict, and the district court declared a mistrial. Prior to the second trial, the Government dismissed one of the false statements counts. In addition, Dr. Hamilton noticed her intent to call an expert witness, but the district court excluded the witness's testimony.
At the second trial, the Government presented testimony from: a Medicare claims analyst; two of Dr. Hamilton's former employees; the three patients associated with the false statements counts; three HHA owners to whom Dr. Hamilton certified patients (and who had already pled guilty to healthcare fraud charges); an HHA recruiter (who had pled guilty to kickback charges); an HHA owner who met with Dr. Hamilton but did not send patients to her clinic; and a certified fraud examiner who analyzed Medicare claims data and patient files for the Government. Dr. Hamilton testified in her own defense and presented numerous witnesses, including several former employees, a former patient, and four character witnesses.
The jury returned a verdict of guilty on all counts except one of the false statements counts, for which Dr. Hamilton was acquitted. At the close of the Government's case and following the verdict, Dr. Hamilton moved for a judgment of acquittal, which the district court denied. The district court then sentenced Dr. Hamilton to 60 months' imprisonment, a downward variance from the Guidelines range, and $9.5 million in restitution. Dr. Hamilton filed a timely notice of appeal.
Dr. Hamilton challenges the sufficiency of the evidence for each count of conviction: conspiracy to commit healthcare fraud, in violation of 18 U.S.C. § 1349 ; conspiracy to solicit and receive healthcare kickbacks, in violation of 18 U.S.C. § 371 ; and two counts of false statements relating to healthcare matters, in violation of 18 U.S.C. § 1035.
"Where, as here, a defendant has timely moved for a judgment of acquittal, this court reviews challenges to the sufficiency of the evidence de novo. " United States v. Nicholson , 961 F.3d 328, 338 (5th Cir. 2020). "Appellate review is highly deferential to the jury's verdict, and a verdict is affirmed unless, viewing the evidence and reasonable inferences in [the] light most favorable to the verdict, no rational jury ‘could have found the essential elements of the offense to be satisfied beyond a reasonable doubt.’ " United States v. Ganji , 880 F.3d 760, 767 (5th Cir. 2018) (quoting United States v. Bowen , 818 F.3d 179, 186 (5th Cir. 2016) ). However, "a verdict may not rest on mere suspicion, speculation, or conjecture, or an overly attenuated piling of inference on inference." United States v. Pettigrew , 77 F.3d 1500, 1521 (5th Cir. 1996).
The parties largely agree that Dr. Hamilton engaged in the acts underlying the convictions: Dr. Hamilton owned and operated a clinic where she saw patients and certified those patients for home healthcare. Dr. Hamilton had a policy of not releasing the home healthcare certifications until $60 was paid to the clinic per patient. The HHAs regularly paid that $60. Dr. Hamilton and the Government disagree, however, about whether Dr. Hamilton agreed to, and did willfully participate in, a conspiracy with the HHAs. The Government contends that Dr. Hamilton joined in a conspiracy with the HHAs by (1) demanding a $60 kickback from the HHAs in exchange for certifications, and (2) certifying patients for home healthcare that she knew were not homebound. By contrast, Dr. Hamilton contends that the $60 fee was a co-pay that she was permitted to charge under Medicare regulations, that the HHAs paid the $60 on behalf of the patients,...
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