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January 14, 2015

Michigan Physician Sentenced to 15 Months in Prison for Her Role in a $2.1 Million Medicare Fraud Scheme

WASHINGTON—A Michigan physician involved in a $2.1 million home health care fraud scheme was sentenced today to 15 months in prison.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Barbara L. McQuade of the Eastern District of Michigan, Special Agent in Charge Paul M. Abbate of the FBI’s Detroit Field Office and Special Agent in Charge Lamont Pugh III of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Detroit Office made the announcement.

Dr. Paula Williamson, 69, of Redford Township, Michigan, was sentenced by U.S. District Judge Paul D. Borman of the Eastern District of Michigan. In addition to her prison term, Williamson was ordered to pay $1,343,261.61 in restitution.

According to her plea agreement, from August 2009 through October 2012, Williamson conspired with others to commit health care fraud by referring Medicare beneficiaries for home health care services that were medically unnecessary and never provided. Williamson also falsified documents that were used to support false and fraudulent claims to Medicare.

According to her admissions, Williamson signed referrals for a home health care agency known as AMB Healthcare Inc. (AMB), which was located in Farmington Hills, Michigan, and owned by a co-conspirator. AMB needed a physician’s referral to bill Medicare for purported home health care services. Williamson admitted that, at the request of her co-conspirators, including the owner of AMB, she falsified medical documentation and certified Medicare beneficiaries as homebound—a requirement for Medicare reimbursement—when, in fact, she had never examined nor even met the beneficiaries, and they were not homebound. AMB used the falsified documents to support fraudulent claims to Medicare for home health care services that were never rendered and not medically necessary.

Between April 2009 and December 2012, Medicare paid AMB approximately $2.1 million for purported home health care services. Of that amount, approximately $1.3 million was based on Williamson’s false home health referrals.

This case was investigated by the FBI and HHS-OIG, and was brought by the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Eastern District of Michigan. The case was prosecuted by Trial Attorneys Matthew C. Thuesen and Niall M. O’Donnell of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 2,000 defendants who have collectively billed the Medicare program for more than $6 billion. In addition, HHS’s Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Team (HEAT), go to: www.stopmedicarefraud.gov.

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