FL: Patient Recruiter Pleads Guilty to $870,000 Kickback Scheme

Healthcare Facility Fraud

A Florida man pleaded guilty today in the Southern District of Florida for a scheme to receive kickbacks and bribes in exchange for referring Medicare beneficiaries to five South Florida home health agencies for services that the patients did not need and, in many cases, never received.

Ernesto Espinosa, 71, of Miami, pleaded guilty to one count of conspiracy to commit health care fraud. According to court documents, from January 2010 to June 2015, Espinosa and his co-conspirators paid kickbacks to Medicare beneficiaries to recruit them for referral to home health agencies. Espinosa also coached the Medicare beneficiaries, who did not need home health services, on what to say to obtain home health prescriptions from doctors. In exchange for referring these beneficiaries, Espinosa solicited and received kickbacks and bribes from the home health agencies. Espinosa and the home health agencies attempted to disguise these kickbacks and bribes by routing them through shell companies controlled by Espinosa. The home health agencies then submitted false and fraudulent claims to Medicare for services that were not medically necessary and typically not even provided. As a result of this fraud, Espinosa and his co-conspirators caused Medicare to make payments of approximately $870,000 for the bogus claims. Espinosa personally netted approximately $630,000 from the scheme.

Espinosa is scheduled to be sentenced on May 24 and faces up to 10 years in prison. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

Assistant Attorney General Kenneth A. Polite Jr. of the Justice Department’s Criminal Division; Special Agent in Charge Omar Pérez Aybar of the Department of Health and Human Services, Office of the Inspector General (HHS-OIG), Miami Regional Office; Assistant Director Luis Quesada of the FBI’s Criminal Investigative Division; and Special Agent in Charge George L. Piro of the FBI’s Miami Field Office made the announcement.

The FBI and HHS-OIG investigated the case.

Trial Attorneys Kelly M. Lyons, Alexander Thor Pogozelski and Jamie De Boer of the Justice Department’s Fraud Section prosecuted the case.

Press Release