Posted on 07/23/2016 11:37:59 AM PDT by 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.
(Excerpt) Read more at miamiherald.com ...
“the biggest scam is Medicare itself.”
I could never quarrel with that conclusion. I was in my twenties when Hubert Humphrey won passage of it and health care costs immediately began to rise at a much faster rate. It was only two or three years later when I read a report that claimed that a person entering the hospital for a stay under medicare would owe a copay upon leaving the hospital that was greater than the entire bill was before passage of medicare. Thre are millions who will immediately cry and moan and ask how does anyone think people over 65 could survive without medicare now but that is the wrong question. They should ask what would be the situation for those of us over 65 if medicare had NEVER EXISTED! I say the situation would be far better than it currently is just as there is no doubt that all would be better off if the insanity known as Obamacare had never existed. I am 72 and have NEVER presented my medicare card to any doctor or hospital but I think I would still be better off had it never existed.
A case where all would be better off had he just billed for the chemo and never actually administered it.
$1 Billion divided by 20 (facilities) divided by 14 (years) equals more than $3.5 million in illegal charges per facility per year, about half of which was approved and paid. That’s a lot of fraud.
Fraud level is about $60 BILLION a year. http://abcnews.go.com/Politics/medicare-funds-totaling-60-billion-improperly-paid-report/story?id=32604330
SS is as bad as is Medicaid.
DUMB BUTTS gave lucrative DOD medical contract for Tricare Prime and Life to Express Scripts that has been sued multiple times for Fraud. WE are DOD MANDATED to use either the Military Base or ES for daily med scripts. Not all bases carry a full range of meds, we are Medicare/Tricare Life as hubby is career Ret. SCPO 20 yrs service.
>But we need more money and even more government control to fix this...
Come now. It only took FOURTEEN YEARS to catch this fraudster. It’s been HOW long since Medi-theft was started and We the People haven’t caught on to the govt fraudsters yet.
>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.
Just THINK the problems that could be solved if We only had a Right to keep that which was ours? Just spit-balling, but maybe something along the lines of “...nor shall private property be taken for public use, without just compensation.”
Or, even *BETTER* yet: “Neither slavery nor involuntary servitude, except as a punishment for crime...shall exist within the United States, or any place subject to their jurisdiction.”
Yep...About 10 years ago I was at a Financial Crimes conference in San Francisco. One workshop I attended was put on by some feds who estimated that Russian mafia medical fraud just in California was 600 million a year....
a rookie accountant could figure some of this crap out...
disability is another scam....
Nowadays “disability” often just means “unemployment back-up plan”; the government opened the gates to all just to hide true unemployment/extend “unemployment” benefits permanently.
A co-worker described how she was attending some type of therapy, and her therapist told her that she was done - but since more visits were covered by our insurance she should keep going. She initially accepted, then declined when she didn’t have sufficient vacation time left to cover the appointments. She described this to me with no sense of shame in being complicit in such an obvious scheme...
This guy is probably guilty as sin - but the right of the government to determine after the fact that a Medicare service was "not necessary" is subject to a constantly changing mass of confusing and sometimes contradictory rules that put every provider at risk every day.
Services that were charged but not performed are easy to understand, easy to prove, and easy to prosecute. That's "hard" Medicare fraud.
Services that were charged, but were "not necessary"? That's another matter entirely.
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