Tuesday, October 16, 2012

Eulises Escalona was Sentenced to 120 Months in Prison for $42 Million Health Care Fraud Scheme

Source- http://www.justice.gov/opa/pr/2012/October/12-crm-1241.html

WASHINGTON – The owner and operator of a Miami health care agency was sentenced today to 120 months in prison for his participation in a $42 million home health Medicare fraud scheme, announced Assistant Attorney General Lanny A. Breuer of the Justice Department’s Criminal Division; U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida; Michael B. Steinbach, Acting Special Agent-in-Charge of the FBI’s Miami Field Office; and Special Agent-in-Charge Christopher B. Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations Miami Office.

Eulises Escalona, 44, of Monroe County, Fla., was sentenced today by U.S. District Judge Joan A. Lenard in the Southern District of Florida. In addition to sentencing Escalona to prison, Judge Lenard ordered him to pay $26.5 million in restitution.

On Aug. 2, 2012, Escalona pleaded guilty in the Southern District of Florida to one count of conspiracy to commit health care fraud.

According to court documents, 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. Escalona pleaded guilty to conspiring with patient recruiters for the purpose of billing the Medicare program for unnecessary home health care and therapy services. Escalona and his co-conspirators paid kickbacks and bribes to patient recruiters in return for patients, prescriptions, Plans of Care (POCs) and certifications for medically unnecessary therapy and home health services for Medicare beneficiaries. Escalona and co-conspirators also paid kickbacks and bribes directly to physicians, who provided home health and therapy prescriptions, POCs and medical certifications to Escalona and his co-conspirators. Escalona used these prescriptions, POCs and medical certifications to fraudulently bill the Medicare program for home health care services, which Escalona knew was in violation of federal criminal laws.

According to court documents, at Willsand Home Health, patient files for Medicare beneficiaries were falsified to make it appear that such beneficiaries qualified for home health care and therapy services when, in fact, many of the beneficiaries did not actually qualify for such services. Escalona knew that in many cases the patient files at Willsand Home Health were falsified.

From approximately January 2006 through November 2009, Escalona and his alleged co-conspirators submitted approximately $42 million in false and fraudulent claims to Medicare, which paid approximately $27 million on those claims.

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