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

Miami Herald ^ | JULY 22, 2016 | JAY WEAVER

[reaganaut1]

One of the state’s wealthiest healthcare operators was arrested 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 the indictment, those kickbacks were “disguised” as payments for escort services for Esformes as well as related travel and hotel expenses.

Justice Department officials — along with South Florida’s U.S. attorney, the FBI and Health and Human Services agents — described the Esformes case as one for the record books in the nation’s long-standing battle against healthcare fraud. They 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.

[reaganaut1]

People are more careful spending their own money than the government is spending taxpayer money.

[E. Pluribus Unum]

There are bigger ones than that out there.

[BeauBo]

We shouldn’t jump to conclusions,

...aaaand they’re Democrats.

[2banana]

But we need more money and even more government control to fix this...

[SoFloFreeper]

the biggest scam is Medicare itself.

[txrefugee]

This bunch of immigrants was just trying to make it in America, doncha know. Unfortunately, they didn’t donate enough of their ill-gotten gains to the Clinton Family Crime Syndicate and the DNC, something Soros is careful to do. He will not be investigated by the FBI....unlessTrump is elected.

[HiTech RedNeck]

The nod, wink it burns.

[Still Thinking]

Hey, they were just stealing the money Americans wouldn’t steal! Nothing to see here.

[knarf]

Check their political donations records.

[stayathomemom]

I can't imagine what the fines will be like in this case. Years ago, when my husband was in private practice, he used to subscribe to a magazine called Medical Economics. Every month there were horror stories like: "My Office Manager Nearly Destroyed My Career!" describing office personnel who would bilk Medicare/Medicaid or insurance companies. The fines per incident seemed huge. The physician was also liable unless he could prove he was not involved. I told my husband to drop his subscription, as he didn't need that angst in his life. They were interesting stories though.

[M Kehoe]

I wonder what gov. Rick Scott thinks about this?

5.56mm

[headstamp 2]

Hope Hillary cashed the campaign donation fast.

[Secret Agent Man]

Yup, and they all were the ones jumping on the obamacare bandwagon.

[stayathomemom]

There are bigger ones than that out there.

In the Detroit area there was a case of an oncologist who subjected hundreds of people to unnecessary chemotherapy in order to pocket the money from the treatments. What an evil thing to do. He had to pay back $17.6 million dollars to the government for the fraudulent claims and was sentenced to 45 years in jail.

[polymuser]

Fraud busting was a component of R healthcare reform proposal in the 90’s. Along with waste reduction, tort reform, choice, medical IRAs, streamlining, etc.

[volunbeer]

There is a sickening amount of fraud and waste in government programs. Absolutely sickening. It’s not just medicare either although that seems to be the easiest one to scam. Social security fraud, welfare fraud, day care programs, student loans, disability fraud, unemployment, section 8 housing, military procurement, government grants, and far more. This is easily hundreds of billions of dollars each year.

[MeneMeneTekelUpharsin]

Authorities just recently were told the suspects had complimented Trump and an investigation was launched.

[E. Pluribus Unum]

How much of that $17.6 million was left for them to collect?

[Cobra64]

This crap would stop if the perps were drawn and quartered.

[Cobra64]

If Trump has the time to look into this, it will stop.