Florida Residents Charged in the Largest Medicare Fraud Scheme to Date

Conspirators filed over $1 billion in false Medicare and Medicaid claims.

The US Department of Justice recently charged 3 Florida residents who allegedly orchestrated a $1 billion Medicare fraud scheme.

This scheme, ongoing since 2009, involved more than 30 nursing homes and assisted living facilities. The owner of the facilities, a hospital administrator, and a physician’s assistant, were all charged with conspiracy, money laundering, and healthcare fraud, according to a press release from the US Attorney’s Office in Florida.

“This is the largest single criminal health care fraud case ever brought against individuals by the Department of Justice, and this is further evidence of how successful data-driven law enforcement has been as a tool in the ongoing fight against health care fraud,” said Assistant Attorney General Leslie L Caldwell.

The involved parties allegedly admitted patients to their skilled nursing home care facilities or assisted living facilities, although a majority of these patients did not qualify for the services. These patients would then receive unnecessary services billed to Medicare and Medicaid, according to the Attorney General.

The conspirers are also alleged to have received kickbacks in order to recommend the beneficiaries receive care from mental health centers and home health providers. These facilities also billed Medicare and Medicaid for unnecessary services.

Kickbacks were received as cash or disguised as payments to charities, payments for service, and false lease documents, according to the release.

The main conspirator and owner of the facilities, Philip Esformes, was charged with obstruction of justice for allegedly attempting to aid another co-conspirator flee the country following their arrest in 2014. This person is not being charged for the alleged crime.

The 3 conspirators were also previously charged for similar crimes in 2006. Esformes paid $15.4 million to settle similar fraud claims, but continued the activities, according to the press release. It is alleged that the conspirators used more advanced money laundering techniques to hide these activities from the federal government.

“Health care executives who exploit patients through medically unnecessary services and conspire to obstruct justice in order to boost their own profits — as alleged in this case – have no place in our health care system,” said Special Agent in Charge Shimon R Richmond. “Such actions only strengthen our resolve to protect patients and the US taxpayers.”