Dive Brief:
- Philip Esformes, operator of the Chicago-based Esformes Network of skilled nursing homes and assisted living facilities in Florida, has been denied bond for his alleged, unprecedented role in bilking Medicare and Medicaid of $1 billion over the course of 14 years, according to a report from the Chicago Tribune.
- As a result, Esformes--who has remained in the Miami Federal Detention Center since being arrested July 22--will stay there as he awaits trial, the report says. The trial will begin Feb. 6, 2017.
- The move came despite letters of support for Esformes, a major community figure, and his pleas that the court consider release under tight restrictions, including 24-hour monitoring at his own expense, and lack of internet or cellphone access, the report added.
Dive Insight:
The decision highlights the unique scope of the alleged fraud, which was reported in July to be "the largest single criminal health care fraud case ever brought against individuals by the Department of Justice," by Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division.
To further make their point, the DOJ broke from procedure last month with an unusually early disclosure of key evidence regarding a secretly recorded conversation in which Esformes is allegedly heard offering assistance to help a co-conspirator get out of the U.S. to avoid trial.
Esformes could potentially receive a life sentence if convicted in the historic case, the Tribune reported.
The case demonstrates not just the DOJ's hard line on fraud, but the potential for fraud to pervade through an entire well-regarded system and beyond, involving kickbacks and bribes with healthcare regulators, medical professionals and suppliers to allegedly cover up illegal admissions and unnecessary treatments--as well as the promising of drugs to addicts in exchange for staying in system facilities.
Investigators said in July that data-driven law enforcement was key in the case. Venson Wallin, consulting managing director at accounting firm BDO, previously shared with Healthcare Dive that health system data needs to be properly monitored from within to avoid the flourishing of fraud. “You need to know what’s going on in your shop from a data perspective,” he said.