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Former Home Health Owner Sentenced to 20 Years in Prison over $57 Million Medicare Fraud

A Florida man who formerly owned and managed three Miami-area home health agencies has been sentenced to serve 20 years in federal prison and ordered to pay millions in restitution for his role in a $57 million Medicare fraud scheme. U.S. District Judge Beth Bloom sentenced Khaled Elbeblawy. In addition to prison time, the court ordered him to pay $36.4 million in restitution.

The court convicted Elbeblawy in January on one count of conspiracy to commit health care fraud and wire fraud. Additionally, the court convicted him on one count of conspiracy to defraud the U.S. and pay health care-related kickbacks. He had been charged in the scheme seven months earlier, being among the 243 people nationwide arrested by the Medicare Fraud Strike Force.

The Fraud

Elbeblawy managed Willsand Home Health Agency Inc., and owned JEM Home Health Care LLC and Healthy Choice Home Services Inc. Prosecutors presented evidence that between January 2006 and May 2013, Elbeblawy and his co-conspirators submitted about $57 million in false claims to Medicare. Medicare actually paid about $40 million of the false claims.

The government had alleged that the claims were based on services that patients didn’t medically need and/or were never provided. According to the government, the company procured the patients by paying kickbacks to doctors, patient recruiters and staffing groups.

The court will sentence Cynthia Vilches, the former co-owner of Healthy Choice, on Oct. 13, and she has pled guilty to one count of conspiracy to commit health care fraud.

A Massive Operation

Elbeblawy’s case was one of 36 that courts initiated in June 2015 in the Southern District of Florida. It was part of a far-reaching coordinated sweep that covered 17 federal districts from Florida to Alaska. Prosecutors charged a wide variety of medical professionals with falsely billing $172 million for Medicare services.

The crackdown involved more than 900 law enforcement personnel and seven states attorneys general. It was the Medicare Fraud Strike Force’s largest action ever. The US Department of Health and Human Services’ Office of Inspector General founded the Medicare Strike Force 2007. 73 of those charged were in the Southern District of Florida. They accounted for more than $262.5 million in false billings. Proportionally, they made up 30 percent of the total Defendants and 37 percent of the alleged false claims. The Medicare Fraud Strike Force has charged almost 2,900 Defendants since its creation in 2007. These defendants had collectively billed the Medicare program for more than $10 billion.

Source: Law360.com

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