Home Health Agencies Involved in the Largest Single Medicare Fraud Scheme

Posted on Wednesday, July 27, 2016 6:05 PM

The Department of Justice (DOJ) enforced charges against 30 Miami-area health care facilities in the largest single Medicare fraud scheme ever, totaling $1 billion. The owner, Phillip Esformes, 47, was charged with the following: conspiracy, obstruction, money laundering and health care fraud.

Esformes was involved with several schemes, including skilled nursing and assisted living facilities and was referred to as the Esformes Network.

“This is the largest single criminal health care fraud case ever brought against individuals by the Department of Justice, and this is further evidence of how successful data-driven law enforcement has been as a tool in the ongoing fight against health care fraud,” said Assistant Attorney General Leslie R. Caldwell.

Esformes ran thousands of facilities where Medicare beneficiaries did not qualify for skilled nursing home care or for placement in an assisted living facility, according to the DOJ. Esformes and his co-conspirators—Odette Barcha, 49, and Arnaldo Carmouze, 56—admitted Medicare and Medicaid patients to these facilities where they received medically unnecessary services that were billed to the federal payers.

Additionally, the trio received kickbacks for sending the beneficiaries to other health care providers who also performed services that were medically unnecessary, according to the DOJ.

“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 care—have no place in our health care system,” said Shimon R. Richmond, special agent in charge of the HHS-OIG. “Such actions only strengthen our resolve to protect patients and the U.S. taxpayers.”

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