Home Health Care Florida man convicted in $1.3B Medicare and Medicaid fraud scheme

Florida man convicted in $1.3B Medicare and Medicaid fraud scheme

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Following an eight-week trial, Philip Esformes, 50, of Miami Beach, Florida, was found guilty for his role in a fraud scheme that involved more than $1.3 billion in fraudulent claims to Medicare and Medicaid for services that weren’t provided, weren’t medically necessary or were procured through the payment of kickbacks.

His sentencing has not been scheduled.

It is the largest healthcare fraud scheme ever charged by the Department of Justice, according to a DOJ announcement.

Esformes was convicted of the following:

  • One count of conspiracy to defraud the United States
  • Two counts of receipt of kickbacks in connection with a federal healthcare program
  • Four counts of payment of kickbacks in connection with a federal healthcare program
  • One count of conspiracy to commit money laundering
  • Nine counts of money laundering
  • Two counts of conspiracy to commit federal program bribery
  • One count of obstruction of justice before U.S. District Judge Robert N. Scola Jr.

From January 1998 to July 2016, Esformes led a conspiracy involving assisted living facilities and skilled nursing facilities that he owned, according to evidence presented at trial. The evidence showed he bribed doctors to admit patients to his facilities, where they often didn’t receive appropriate services or received medically unnecessary services that were then billed to Medicare and Medicaid.

Additionally, the evidence established that Esformes received more than $37 million from the scheme. He used the money to buy luxury cars and a $360,000 watch, as well as and to bribe the basketball coach at the University of Pennsylvania in exchange for his help in getting Esformes’ son into the school, according to the DOJ.

“Even beyond the vital dollars lost though, Esformes exploited and victimized patients by providing inadequate medical care and poor conditions in his nursing homes,” HHS-OIG Special Agent in Charge Shimon Richmond said in a statement. “Along with our law enforcement partners, we will continue the fight against such parasites.”

Esformes’ co-conspirators — Arnaldo Carmouze and Odette Barcha — pleaded guilty. Carmouze, a physician assistant, pleaded guilty to conspiracy to commit healthcare fraud. He’s scheduled to be sentenced on April 10. Barcha pleaded guilty to one count of conspiring to violate the anti-kickback statute. She was ordered to pay $704,516 in restitution and was sentenced on April 3 to serve 15 months in prison followed by three years of supervised release.

Photo: Alex_str, Getty Images

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