WASHINGTON – A patient recruiter for a Houston-based home health care company pleaded guilty today in connection with a $5.2 million Medicare fraud scheme, announced the Departments of Justice and Health and Human Services (HHS).
Sammie Wilson, 69, pleaded guilty before U.S. District Court Judge Nancy Atlas in Houston to conspiracy to commit health care fraud. According to court documents, Family Healthcare Group (Family Group) purported to provide skilled nursing to Medicare beneficiaries. The owner hired Wilson and other co-conspirators to recruit Medicare beneficiaries for the purposes of filing false claims with Medicare. According to court documents, Family Group used the Medicare beneficiary numbers to submit claims to Medicare for skilled nursing that was medically unnecessary and/or not provided. In return, Wilsonwas paid kickbacks for referring beneficiaries for services that she knew were not medically necessary and/or not rendered.
According to court documents, Wilson herself is a Medicare beneficiary. Family Group billed Medicare for providing the defendant services that were not medically necessary and/or not provided.
At sentencing, scheduled for July 18, 2011, Wilson faces a maximum sentence of 10 years in prison.
Today’s guilty plea was announced by Assistant Attorney General of the Criminal Division Lanny A. Breuer; U.S. Attorney José Angel Moreno of the Southern District of Texas; Special Agent-in-Charge Richard C. Powers of the FBI’s Houston Field Office; Special Agent-in-Charge Mike Fields of the Dallas Regional Office of HHS Office of Inspector General (HHS-OIG), Office of Investigations; and Texas Attorney General Greg Abbott.
This case is being prosecuted by Trial Attorneys Charles D. Reed and Sam S. Sheldon of the Criminal Division’s Fraud Section. The case was brought as part of the Medicare Fraud Strike Force, supervised by the U.S. Attorney’s Office for the Southern District of Texas and the Criminal Division’s Fraud Section.
Since their inception in March 2007, Medicare Fraud Strike Force operations in seven districts have obtained indictments of more than 825 individuals who collectively have falsely billed the Medicare program for more than $2 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov