On August 30, 2016, Khaled Elbeblawy was sentenced to 20 years in federal prison and ordered to pay nearly $36.5 million in restitution for his role in a Medicare home health fraud scheme. The sentence follows a two-week trial which culminated on January 21, 2016 when a South Florida jury found Elbeblawy guilty of one count of conspiracy to commit health care fraud and wire fraud and one count of conspiracy to defraud the United States and pay health care kickbacks.
The evidence at trial showed Elbeblawy managed Willsand Home Health Agency Inc. and owned JEM Home Health Care LLC and Healthy Choice Home Services Inc., all in the Miami area. Trial evidence also showed that from approximately 2006 to 2013 Elbeblawy and his co-conspirators billed Medicare for home health services that were not medically necessary and often never even provided. To further this scheme, Elbeblawy and his co-conspirators paid kickbacks to doctors, patient recruiters and staffing groups in exchange for Medicare beneficiary referrals to the home health agencies. Over this time period, the three home health agencies submitted approximately $57 million in false and fraudulent claims to Medicare and received payments totaling approximately $40 million for those claims.
One of Elbeblawy’s co-conspirators, Eulises Escalona, was sentenced to 10 years in prison after pleading guilty to one count of conspiracy to commit health care fraud. Another co-conspirator, Cynthia Vilches, has pled guilty to one count of conspiracy to commit health care fraud and is scheduled to be sentenced on October 13, 2016.
The case was brought as a part of the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force is now operating in nine cities across the country and has charged nearly 2,900 defendants who have collectively billed the Medicare program for more than $10 billion.
The cases against Elbeblawy and his co-conspirators are criminal cases. However, under the qui tam provisions of the False Claims Act, whistleblowers with information about similar fraud against the government may bring a civil case on behalf of the United States. If successful, the government can recover three times the amount the defendants fraudulently billed the government. The whistleblower, who originally filed the qui tam case, is entitled to 15-30% of the government’s recovery as well as their attorney’s fees.
To report Medicare fraud, contact Frohsin, Barger & Walthall.