The U.S. federal government has charged three conspirators in the largest single criminal health care fraud case ever brought against individuals, according to the Justice Department.
It was the perfect network – Philip Esformes, 47, ran 30 nursing homes and assisted living facilities, and his co-conspirators are a physician’s assistant (Arnaldo Carmouze, 56) and a hospital administrator (Odette Barcha, 49.)
All of Miami-Dade County, Florida, the three were charged on Friday with conspiracy, obstruction, money laundering and health care fraud. They allegedly using the nursing home patients to abuse Medicare and Medicaid programs, running patients through medical facilities for treatments and services they did not need or qualify for, some of which were even harmful.
Also in on the scheme was a network of other health care providers and medical center who provided kickbacks for steering patients their way, hiding the kickbacks by paying in cash or disguising it as charitable donations.
Assistant Attorney General of the Justice Department’s Criminal Division, Leslie Caldwell, said in a news conference, “Among the thousands of people cycled through the fraudulent network were, for example, drug addicts who were allegedly prescribed opioids – including OxyContin and Fentanyl – and other narcotics in order to entice them to stay in facilities where they didn’t belong.”
Two other co-conspirators were arrested earlier, in 2014 – Guillermo and Gabriel Delgado. According to Friday’s indictment, Esformes had attempted to buy an airline ticket for Guillermo Delgado to help him get out of the country before a trial in Miami.
It’s not the first time – according to court documents, in 2006 Esformes paid $15.4 million in fines for health care fraud, but through a money laundering scheme, he and his co-conspirators were able to continue the crimes undetected, until the FBI started using advanced data analysis and were able to bust the scheme wide open.
“Esformes is alleged to have been at the top of a complex and profitable health care fraud scheme that resulted in staggering losses – in excess of $1 billion,” said Special Agent in Charge Piro. “The investigators who unraveled this intricate scam are to be commended for their diligence and commitment to root out fraud within our health care system.”
“Health care executives who exploit patients through medically unnecessary services and conspire to obstruct justice in order to boost their own profits – as alleged in this case – have no place in our health care system,” said Special Agent in Charge Richmond. “Such actions only strengthen our resolve to protect patients and the U.S. taxpayers.”
“Medicare fraud has infected every facet of our health care system,” said U.S. Attorney Ferrer. “As a result of our unrelenting efforts to combat these pernicious schemes, the Criminal Division, the U.S. Attorney’s Office and our law enforcement partners continue to identify and prosecute the criminals who, driven by greed, steal from a program meant for our aged and infirmed to increase their personal wealth.”
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