CNBC reported the “largest single criminal health-care fraud case ever brought against individuals” by the U.S. Justice Department — an alleged Medicare fraud and money laundering scheme that netted participants a whopping $1 billion since 2009. Philip Esformes, the owner of more than 30 Miami-area skilled nursing and assisted living facilities, as well as a hospital administrator and a physician’s assistant were charged in an indictment with conspiracy, money laundering and health-care fraud, the U.S. Attorney’s office in Miami said. “Esformes is alleged to have been at the top of a complex and profitable health-care fraud scheme that resulted in staggering losses — in excess of $1 billion,” said FBI Special Agent in Charge George Piro. Prosecutors say that Esformes operated the Esformes Network for “more than 14 years … to enrich himself through false and fraudulent billings.”
The indictments claim that the massive scam cycled thousands of Medicare and Medicaid beneficiaries through his Esformes Network facilities despite the fact they didn’t qualify for such care and helped Esformes, fund a lavish Trumpian lifestyle that included private jets, a $600,000 watch, meetings with escorts in hotel rooms, and a private basketball coach for his son.
At those facilities, prosecutors said, they also “received medically unnecessary services that were billed to Medicare and Medicaid,” the government-run health programs that cover senior citizens and the poor.
“Furthermore, Defendant [Esformes] and his co-conspirators preyed upon his beneficiaries addictions by providing them with narcotics so that the beneficiaries would remain in Esformes Network facilities, allowing the cycle of fraud [to] continue,” prosecutors said in a court filing. “Among the thousands of people cycled through the fraudulent network were, for example, drug addicts who were allegedly prescribed opioids – including OxyContin and Fentanyl – and other narcotics in order to entice them to stay in facilities where they didn’t belong,” she said at a news conference.
Prosecutors said Esformes faces a potential prison term of life imprisonment under federal sentencing guidelines.
In addition to Esformes, 49-year-old Odette Barcha, who had been director of outreach programs at Larkin Community Hospital, and physician’s assistant Arnaldo Carmouze, 56, also were charged in the case and arrested. Esformes and his co-conspirators are alleged to have further enriched themselves by receiving kickbacks in order to steer Medicare beneficiaries to other health-care providers — including community mental health centers and home health-care providers — who also performed medically unnecessary treatments that were billed to Medicare and Medicaid, the office said.
According to court documents, Esformes paid $15.4 million in 2006 to resolve civil federal health care fraud claims for similar charges. But authorities said Esformes was able to continue with alleged crimes after that date through a sophisticated money laundering scheme.
See additional article at Fox News.