Justice Department charges three in $1 billion Medicare fraud scheme

Philip Esformes

The Justice Department on Friday unsealed charges in its largest-ever criminal health-care-fraud case, charging three individuals with using a network of doctors, hospitals and health-care providers across South Florida to improperly bill more than $1 billion to Medicare and Medicaid.
Philip Esformes, the owner of more than 30 Miami-area skilled-nursing and assisted-living facilities, was the project’s mastermind, the indictment alleged. He and two co-defendants, along with other co-conspirators, allegedly paid and received bribes and kickbacks to get thousands of patients admitted to facilities Mr. Esformes controlled.
In those facilities, they were often given medically unnecessary and sometimes harmful treatments, which were then billed to Medicare and Medicaid, according to court papers.
Esformes attorneys Marissel Descalzo and Michael Pasano of Carlton Fields said their client “adamantly denies these allegations and will fight hard to clear his name.”
The case was brought as part of an interagency Medicare Fraud Strike Force, which operates in nine locations across the country, officials said. Since its creation in March 2007, the task force has charged nearly 2,900 defendants who have collectively billed the Medicare program for more than $10 billion, they said.
Fraud continues to plague the roughly $600 billion Medicare program, though new criminal cases have slowed in recent years. Fraud enforcers have brought fewer cases since 2013, but convictions and settlements since the start of the decade have netted Medicare between $1 billion and $2.5 billion annually, according to a report from the Department of Health and Human Services’ Office of the Inspector General.