Dr. Edward “Eddie” Hamilton, a prominent Nashville pediatrician, pleaded guilty to a misdemeanor count healthcare fraud last Thursday in United States District Court. According to the press release, Hamilton is excluded from participation in all federal health care programs for twenty years and is ordered to pay nearly $1.6 million in restitution and FCA damages.
“The penalties set forth in the plea agreement and the civil settlement should send a clear message to those who defraud health care programs, especially those programs intended to help our nation’s most vulnerable people – our children,” United States Attorney David Rivera said in the release.
This settlement resolves allegations that Hamilton knowingly up coded billings for infant auditory screening exams to Tennessee’s Medicaid program TennCare and commercial insurance programs in a scheme that ran from January 2007 through November 2012. In one example, Hamilton billed for the infant hearing exams that it performed at Baptist Hospital as comprehensive auditory exams, even though it performed less expensive auditory exams. The investigation revealed that his practice, Centennial Pediatrics, P.C., did not even have equipment capable of performing the comprehensive tests for which it billed.
This matter was investigated by the Department of Health and Human Services Office of Inspector General, the Federal Bureau of Investigation, the Tennessee Bureau of Investigation, the Tennessee Attorney General’s Office, and the United States Attorney’s Office for the Middle District of Tennessee.
Assistant United States Attorneys Lisa Rivera and Christopher C. Sabis prosecuted the case.