Miami-Dade healthcare operator convicted of $56 million Medicare scam

An operator of Miami-Dade healthcare agencies was found guilty on Thursday of falsely billing $56 million to the taxpayer-funded Medicare program while paying bribes to doctors and recruiters to supply patients who did not need or receive the costly medical services in their homes.

Khaled Elbeblawy, 39, of Miramar, owned and managed three agencies that were paid $40 million by Medicare as a result of his fraudulent claims. He was convicted of conspiring to bilk the program and pay kickbacks for patient referrals.

Elbeblawy's agencies falsely billed Medicare for insulin injections, physical therapy and nursing care for patients who pretended to need the services in their homes, Miami federal jurors found. Crooked doctors signed off on their plans so the patients could qualify for the purported services.

Back in 2012, Elbeblawy’s business partner, Eulises Escalona, 47, pleaded guilty to fleecing Medicare and was sentenced to 10 years in prison.

The Justice Department’s prosecution highlighted the rampant bogus billing activity in South Florida’s home healthcare industry during the past decade. The two business partners are among dozens of healthcare operators convicted of using their agencies as fronts to generate millions of dollars in false claims — a practice that grew so out of control that Medicare clamped down on excessive billing for homebound diabetic patients.

According to Justice Department lawyers, Elbeblawy first worked for Willsand Home Health Agency and then expanded the business to include JEM Home Health Care and Healthy Choice Home Health Services between 2006 and 2013.

Wislland’s owner, Escalona, first put Elbeblawy in charge of paying bribes and kickbacks to doctors, patient recruiters and staffing companies, prosecutors said at trial. The vast majority of patients did not need or qualify for home healthcare services covered by Medicare.

As Willsand grew, the two men became partners and purchased another agency, JEM. Both continued to use the same network of doctors, patient recruiters and staffing companies to file phony claims with Medicare, prosecutors Nicholas Surmacz and Vasanth Sridharan said.

In 2009, Medicare suspended JEM’s license as a Medicare provider on suspicion of fraud. Then, Elbeblawy and his ex-wife bought the third agency, Healthy Choice, where prosecutors said he continued to run the same scheme.

This story was originally published January 22, 2016 at 11:22 AM with the headline "Miami-Dade healthcare operator convicted of $56 million Medicare scam."