MIAMI (CBSMiami) — The owner and operator of a Miami health care agency pleaded guilty on Thursday for his participation in a $42 million home health Medicare fraud scheme, announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS).
Eulises Escalona, 43, pleaded guilty before a U.S. District Judge to one count of conspiracy to commit health care fraud.
In addition, as part of his plea agreement, Escalona agreed to forfeit to the government two residential properties and cash proceeds of the fraud contained in several bank accounts.
According to court documents, Escalona was the owner of Willsand Home Health Inc., a Florida home health agency that claimed to provide home health care and physical therapy services to eligible Medicare beneficiaries.
One arm of the operation involved Escalona paying kickbacks and bribes to those recruiters. In return, the recruiters provided patients to Willsand Home Health. The patients, Medicare beneficiaries, were used to bill Medicare for $42 million in unnecessary home health care and therapy services.
Plea documents reveal the patients’ files were falsified to make it appear that these Medicare beneficiaries qualified for the services when, in fact, many did not.
Another arm of the operation involved Escalona and his co-conspirators paying off physicians directly. In this illegal exchange, the physicians gave home health and therapy prescriptions, POCs and medical certifications to Escalona and his co-conspirators.
The crimes resulted in $42 million in false and fraudulent Medicare claims that were filed between January 2006 and November 2009, according to plea documents.
This case was brought as part of the Medicare Fraud Strike Force, which operates in nine cities across the country.
Since its inception in March 2007, it has charged more than 1,330 defendants who have collectively billed the Medicare program for more than $4 billion.
To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.