Feds Break Up Largest Medicare Scam In U.S. History
One of the wealthiest healthcare operators in the state of Florida was arrested Friday on his Miami Beach waterfront estate after being charged with orchestrating the largest Medicare fraud scam in the history of the U.S. The Miami Herald reports this Medicare fraud scam amounted to $1 billion in fraudulent charges.
Philip Esformes, the 47-year-old healthcare operator from Florida, along with two other defendants, are being accused of exploiting his network of roughly 20 skilled-nursing and assisted-living facilities in order to swindle Medicare by filing false claims for services that were unnecessary or never provided to the patients for roughly 14 years.
Feds nab ringleaders of $1bn Medicare fraud https://t.co/ALyzVXVXEM
— @lnnie (@Lnnie) July 23, 2016
According to the indictment, an unidentified local hospitals referred thousands of Medicare patients to his network through a kickback of payments to medical staff.
Esformes is being charged with conspiring with 56-year-old Palmetto Bay physician’s assistant, Arnaldo Carmouze, and 49-year-old longtime director of outreach programs, Odette Barcha. Authorities have not confirmed whether or not the local hospital was part of the Medicare scam.
The Medicare scam doesn’t stop there as this healthcare operator is also accused of referring his own network to other known convicted health care fraud offenders who have a history of cheating the Medicare system for mental health, prescription drugs, and home health care services. The kickbacks the healthcare operator was receiving for the Medicare scam had been disguised as payments for escort services as well as escort related travel and hotel expenses.
Three charged in $1 billion Medicare fraud scheme https://t.co/Y2lH4JQ2Rr
— PBS NewsHour (@NewsHour) July 22, 2016
According to the Miami Herald, the Justice Department is describing the Esformes case as record breaking in the nation’s battle against health care fraud. It has been noted that in addition to his healthcare network billing Medicare roughly $1 billion for fraudulent medical services, Medicare also paid his skilled-nursing facility and assisted-living facility roughly $500 million since the year 2009.
“This is the largest single criminal health care fraud case ever brought against individuals by the Department of Justice,” the criminal division’s assistant attorney general, Leslie R. Caldwell, said.
“The magnitude of alleged false claims in this scheme is staggering and outrageous, even by South Florida healthcare fraud standards. This case illustrates once again that Medicare fraud has infected every aspect of the healthcare system.”
In order to put this Medicare scam in context for some people to understand, this healthcare network billed an amount equal to the money convicted Fort Lauderdale Ponzi schemer Scott Rothstein ended up making while he was ripping off investors from the states of Florida to New York. Scott Rothstein is also in the books as one of the biggest financial frauds in the state of Florida.
RedState reports this medicare scam is a prime example of why so many people do not approve of government-funded health insurance.
Three Individuals Charged in $1 Billion Medicare Fraud and Money Laundering Scheme https://t.co/7Mpssx77m9 pic.twitter.com/nhnmRqSG9A
— Justice Department (@TheJusticeDept) July 22, 2016
On Friday, the attorneys of Esformes, Marissel Descalzo and Michael Pasano, issued a statement declaring the healthcare operator had done nothing wrong. The attorneys claim they will be working hard to clear his name as he is a well-respected businessman.
“Mr. Esformes is a respected and well-regarded businessman. He is devoted to his family and his religion. The government allegations appear to come from people who were caught breaking the law and are now hoping to gain reduced sentences. Mr Esformes adamantly denies these allegations and will fight hard to clear his name.”
Prosecutors are seeking to detain Esformes until his trial as they are considering him to be a danger to the community. His detention hearing is scheduled to take place on August 1 at the Miami Federal Court.
Why do you think Esformes was able to get away for this Medicare scam for nearly a decade and a half before anyone noticed what he was doing? More importantly, will Medicare get any of the money this man scammed from them back?
[Photo by Spencer Platt/Getty Images]