The US Department of Justice announced that Khaled Elbeblaswy, the former owner and manager three Miami-area home health agencies, was sentenced to 20 years in prison and ordered to pay $36.4 million in restitution for his role in a $57 million Medicare fraud scheme.

In January 2016, Elbeblawy was convicted of conspiracy to commit healthcare fraud and conspiracy to defraud the United Stated and pay health care kickbacks. Elbeblawy owned both JEM Home Health Care LLC and Healthy Choice Home Services Inc., and also managed Willsand Home Health Agency Inc. According to evidence presented at his trial, from 2006 to 2013, Elbeblawy and his co-conspirators used these three agencies to submit approximately $57 million to Medicare in false and fraudulent claims for home health services that were often never provided or were not medically necessary. Elbeblawy and his co-conspirators also paid kickbacks to physicians, patient recruiters and staffing groups for beneficiary referrals to the agencies. Eulises Escalona, the former owner of Willsand Home Health Agency Inc., is currently serving a ten year prison sentence, and was ordered to pay $26.5 million in restitution. Cynthia Vilches, the former co-owner of Healthy Choice Home Services, Inc., pled guilty to conspiracy to commit healthcare fraud and faces sentencing on October 13, 2016.

The FBI and U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG) investigated this case, which was brought as part of the Medicare Fraud Strike Force (the Strike Force). The Strike Force brings together the efforts of the Office of Inspector General, the Department of Justice, the Offices of the United States Attorneys, the FBI, and local law enforcement to prevent and combat healthcare fraud, waste and abuse. It was first established in March 2007 and currently operates in nine areas throughout the country, including Miami and Tampa Florida, southern Texas, and Dallas Texas. Since its commencement, the Strike Force has charged roughly 2,900 defendants who have jointly billed the Medicare program more than $10 billion.

Due to the efforts of the Strike Force, as well those of the HHS Centers for Medicare and Medicaid Services and HHS-OIG who are working to decrease fraudulent providers, all providers, not just home health agencies, need to intensify their compliance efforts. Amongst other actions, providers should review their current plans to ensure they have covered all aspects of compliance, including the following: a compliance officer and committee; written policies and procedures; effective training and education; effective lines of communication; monitoring and auditing; enforcement of standards; and, detecting and responding to offenses and developing corrective action.

Should you have any questions about this blog topic, or compliance, please contact the author.