Feds break up $1 billion Medicare scam in Miami — the biggest in U.S. history

[Valin]

Miami Herald:

Jay Weaver

July 22 2016

 

One of the state’s wealthiest healthcare operators was arrested on Friday at his Miami Beach waterfront estate on charges of orchestrating the nation’s biggest Medicare fraud scheme — $1 billion.

 

Philip Esformes, 47, charged with two other defendants, is accused of exploiting his network of about 20 Miami-Dade skilled-nursing and assisted-living facilities to fleece the taxpayer-funded Medicare by filing false claims for services that were not necessary or in some instances not provided over the past 14 years.

 

An unidentified local hospital referred some of the thousands of Medicare patients to his network through kickback payments to physicians and other medical professionals, according to an indictment.

 

Esformes is charged with conspiring with Arnaldo Carmouze, 56, a Palmetto Bay physician’s assistant, and Odette Barcha, 49, a former longtime director of outreach programs at Larkin Community Hospital in South Miami. Authorities would not confirm whether that was the local hospital at the center of the alleged scheme.

 

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

(Snip)

 

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H/T Ed Morrissey