The owner and operator of a Miami, Fla. health care agency pleaded guilty on Thursday, Aug. 2, for his participation in a $42 million home health Medicare fraud scheme, announced the Department of Justice in conjunction with the FBI and the Department of Health and Human Services.
Eulises Escalona pleaded guilty to one count of conspiracy to commit health care fraud, and also agreed to forfeit to the government two residential properties and cash proceeds of the fraud conatined in several bank accounts.
Escalona was the owner of Willsand Home Health Inc, a Florida home health agency that purported to provide home health care and physical therapy services to eligible Medicare beneficiaries, court documents show.
However, he conspired with patient recruiters for the purpose of billing the Medicare program for unnecessary services. He and his co-conspirators paid kickbacks and bribes to patient recruiters in return for getting patient referrals to Willsand Home Health, and for prescriptions, Plans of Care, and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries.
The fraud conspirators would also pay kickbacks and bribes directly to physicians in exchange for those medical professionals providing home health and therapy prescriptions, POCs, and medical certifications, which were used to fraudulently bill the Medicare program for services.
Patient files for Medicare beneficiaries at Willsand Home Health were falsified to make it look like those beneficiaries qualified for home health care and therapy services when, in fact, many did not actually qualify for the services, according to plea documents, and Escalona was aware that many of those patient files had been falsified.
Between approximately January of 2006 through November of 2009, Escalona and his co-conspirators submitted approximately $42 million in false and fraudulent claims to Medicare, of which approximately $27 million was paid by Medicare.
Written by Alyssa Gerace