- Philip Esformes, who operated a chain of nursing home facilities in South Florida, was sentenced to 20 years in prison Thursday after he was found guilty of defrauding Medicare and Medicaid through a scheme of kickbacks and money laundering in what the U.S. Department of Justice said is the largest healthcare fraud case in U.S. history.
- After an eight-week jury trial, U.S. District Judge Robert Scola of the U.S. District Court for the Southern District of Florida on Thursday sentenced Esformes to two decades in prison and three years of supervised release.
- The judge will hold a hearing Nov. 21 on the amount of restitution Esformes must pay and the assets he must forfeit. The evidence at trial showed Esformes personally benefited from his fraud to the tune of more than $37 million.
The government has touted its successful use of data-driven law enforcement as key to the successful prosecution of the massive health care fraud scheme.
The FBI and HHS-OIG used advanced data analysis and forensic accounting to uncover the full scope of the scheme, which was investigated by a Medicare Fraud Strike Force team.
The Medicare Fraud Strike Force is part of a joint initiative between the DOJ and HHS to prevent and deter fraud and enforce current anti-fraud laws around the country. Established in 2007, the Medicare Fraud Strike Force, which has 15 strike forces operating in 24 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion, the goverment said.
The Esformes case involved decades of illegal kickbacks and money laundering in connection with fraudulent claims submitted to Medicare and Medicaid for medically unnecessary services.
Esformes was found guilty in April 2019 of one count of conspiracy to defraud the U.S, two counts of receipt of kickbacks in connection with a federal healthcare program and four counts of payment of kickbacks in connection with a federal healthcare program, along with one count of conspiracy to commit money laundering, nine counts of money laundering, two counts of conspiracy to commit federal program bribery and one count of obstruction of justice.
Over a 14-year period, Esformes used a network of corrupt physicians and hospitals to direct patients unqualified for treatment to 30 Florida nursing homes and assisted living facilities operated by Chicago-based Esformes Network, according to the Justice Department. Esformes and his co-conspirators also took kickbacks from other providers for providing patients with medically unnecessary treatments.
A hospital administrator and a physician’s assistant who were also charged in the scam pleaded guilty and were sentenced in April and ordered to pay restitution. Physician’s assistant Arnaldo Carmouzewas sentenced on April to 80 months in prison and was ordered to pay almost $12.6 million in restitution. Co-conspirator Odette Barcha was sentenced to 15 months in prison and three years of supervised release and was ordered to pay $704,516 in restitution.
Esformes faced similar allegations of improperly admitting patients in 2006. He paid $15.4 million to resolve the claims through a civil settlement.