Welcome to DU!
The truly grassroots left-of-center political community where regular people, not algorithms, drive the discussions and set the standards.
Join the community:
Create a free account
Support DU (and get rid of ads!):
Become a Star Member
Latest Breaking News
General Discussion
The DU Lounge
All Forums
Issue Forums
Culture Forums
Alliance Forums
Region Forums
Support Forums
Help & Search
Economy
Related: About this forumThree Individuals Charged in $1 Billion Medicare Fraud and Money Laundering Scheme
Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
Friday, July 22, 2016
Three Individuals Charged in $1 Billion Medicare Fraud and Money Laundering Scheme
The owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator and a physicians assistant were charged with conspiracy, obstruction, money laundering and health care fraud in connection with a $1 billion scheme involving numerous Miami-based health care providers.
(snip)
Philip Esformes, 47, Odette Barcha, 49, and Arnaldo Carmouze, 56, all of Miami-Dade County, Florida, were each charged in an indictment unsealed today. According to the indictment, Esformes operated a network of over 30 skilled nursing homes and assisted living facilities (the Esformes Network), which gave him access to thousands of Medicare and Medicaid beneficiaries. Many of these beneficiaries did not qualify for skilled nursing home care or for placement in an assisted living facility; however, Esformes and his co-conspirators nevertheless admitted them to Esformes Network facilities where the beneficiaries received medically unnecessary services that were billed to Medicare and Medicaid. Esformes and his co-conspirators are also alleged to have further enriched themselves by receiving kickbacks in order to steer these beneficiaries to other health care providers including community mental health centers and home health care providers who also performed medically unnecessary treatments that were billed to Medicare and Medicaid. In order to hide the kickbacks from law enforcement, these kickbacks were often paid in cash, or were disguised as payments to charitable donations, payments for services and sham lease payments, court documents allege.
Esformes and Barcha were also charged with obstructing justice. According to the indictment, following the 2014 arrest of co-conspirators Guillermo and Gabriel Delgado, Esformes attempted to fund Guillermo Delgados flight from the United States to avoid trial in Miami. The indictment further alleges that Barcha created sham medical director contracts following receipt of a grand jury subpoena in June 20, 2016, in order to conceal and disguise the payment of kickbacks she made in exchange for patient referrals for admission to Esformes Network facilities and another Miami-area hospital.
According to court documents, in 2006, Esformes paid $15.4 million to resolve civil federal health care fraud claims for essentially identical conduct, namely unnecessarily admitting patients from his assisted living facilities into a Miami-area hospital. However, Esformes and his co-conspirators allegedly continued this criminal activity-adapting their scheme to prevent detection and continue their fraud after the civil settlement. The indictment alleges that the co-conspirators accomplished this by employing sophisticated money laundering techniques in order to hide the scheme and Esformes identify from investigators. The FBI and HHS-OIG ultimately employed advanced data analysis and forensic accounting techniques and were able to identify the full scope of the fraud scheme.
(snip)
InfoView thread info, including edit history
TrashPut this thread in your Trash Can (My DU » Trash Can)
BookmarkAdd this thread to your Bookmarks (My DU » Bookmarks)
8 replies, 1954 views
ShareGet links to this post and/or share on social media
AlertAlert this post for a rule violation
PowersThere are no powers you can use on this post
EditCannot edit other people's posts
ReplyReply to this post
EditCannot edit other people's posts
Rec (11)
ReplyReply to this post
8 replies
= new reply since forum marked as read
Highlight:
NoneDon't highlight anything
5 newestHighlight 5 most recent replies
Three Individuals Charged in $1 Billion Medicare Fraud and Money Laundering Scheme (Original Post)
nitpicker
Jul 2016
OP
nitpicker
(7,153 posts)1. Link to AAG speech about this case
Sherman A1
(38,958 posts)2. If found guilty
I hope they have the "opportunity" to pay back every dime that was taken illegally. As a taxpayer, I want my money back.
padfun
(1,786 posts)3. I dont think they will give you any money back.
It really doesn't work that way.
Duppers
(28,125 posts)4. Fraud is rampant
Medicare fraud outrunning enforcement efforts
http://www.cnbc.com/2013/09/20/spending-cuts-on-health-care-fraud-probes-hurting-enforcement.html
Does this mean that they will plead the 5th and run for governor and win because the people in Florida aren't very bright.
Firebrand Gary
(5,044 posts)6. Clearly they took notes from how their Governor did it...
sinkingfeeling
(51,459 posts)7. Will they get 6 months probation for their fraud?
golfguru
(4,987 posts)8. Have no worries, Hillary will weed out all fraud in gov't programs!
She will install single payer system, which will be 7 times bigger in monetary size than Medicare, but will have no fraud anywhere! She will also eliminate food stamp fraud, medicaid fraud, rent subsidies fraud, and every other fraud. Government will become fraud-proof under Hillary.