Three Charged in Billion-Dollar Medicare Fraud Scheme

From AllGov:

By Kelli Kennedy, Associated Press

“This is the largest single criminal health care fraud case ever brought against individuals by the Department of Justice,” Assistant Attorney General of the Justice Department’s Criminal Division Leslie Caldwell announced in a statement.

Authorities said Philip Esformes, who ran 30 nursing homes and assisted living facilities, joined with two conspirators and a complex network of corrupt doctors and hospitals to refer thousands of patients to their facilities even though the patients did not qualify for the services. Some of the treatments were harmful, they added.

All of this was done with little regard for the patients, Caldwell said.

“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,” she said at a news conference.

Authorities said Esformes, along with Odette Barcha and Arnaldo Carmouze, also received kickbacks for steering patients to other community health care providers, including mental health centers. When a patient reached their Medicare-imposed length of stay limit at one facility, conspirators simply moved patients to a different facility, Caldwell said, calling it a “ruthlessly efficient” scam.

Authorities allege in court documents that those facilities also billed Medicare and Medicaid for unnecessary services and that kickbacks were often paid in cash or disguised as charitable donations.

Esformes’ two other defendants were identified in court documents as a hospital administrator and a physicians’ assistant. The three were charged Friday with conspiracy, obstruction, money laundering and health care fraud, the indictment said. It’s unclear if they have retained lawyers. Emails sent to Esformes’ lawyers from previous cases were not immediately returned Friday.

According to court documents, Esformes paid $15.4 million …

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