Jul 232016
Charges were filed against one of Florida’s wealthiest healthcare operators in a $1 billion Medicare care fraud scheme, announced the U.S. Attorney’s Office during a press conference in Miami, Florida on July 22, 2016. Federal prosecutors stated this is the biggest Medicare fraud scheme in the nation’s history. This has cost Medicare hundreds of millions of dollars due to fraudulent payments. Medicare is the U.S. governments medical program for the elderly and disabled.

Philip Esformes, 47, was charged at his ocean front estate. Along with two other defendants, he is accused of exploiting his network of about 20 Miami-Dade skilled nursing and assisted living facilities to fleece the taxpayer funded Medicare system by filing false claims for services that were not necessary and in some instances not provided. This has been happening over the past 14 years.

Esformes is charged with conspiring with Arnaldo Carmouze, 56, a Palmetto Bay physician’s assistant, and Odette Barcha, 49, a former director of outreach programs at Larkin Community Hospital in South Miami.

Esformes is also being accused of referring his own network of patients to other convicted healthcare fraud offenders, who had swindled Medicare for mental health, prescription drug and home healthcare services and ended up helping federal investigators target the Miami Beach business executive. According to the indictment, the kickbacks were “disguised” as payments for escort services for Esformes as well as related travel and hotel expenses.

Healthcare fraud has been a battle for a long time. This case is the nation’s largest in regards to heathcare and Medicare fraud. It was noted that while his healthcare network billed $1 billion for fraudulent medical services, Medicare paid Esformes’ skilled nursing and assisted living facilities about $500 million since 2009.

“This is the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice,” the criminal division’s assistant attorney general, Leslie R. Caldwell, said Friday during a news conference at the U.S. attorney’s office in Miami.

Medicare plans already cost the government and US citizens a lot of money. Fraud continues to drive the costs up. It is important that law enforcement continues to target this problem.

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