Miami Nursing Home Executive Convicted in $1 Billion Medicare Scheme

Florida businessman, Philip Esformes, has been convicted in a massive Medicare fraud scheme. The scheme defrauded Medicare over a billion dollars by taking advantage of vulnerable nursing home residents.

Philip Esformes, a Miami Beach health care executive, was recently found guilty in the largest Medicare fraud case in history. Esformes ran his scheme for 18 years, defrauding the government over $1 billion by cycling nursing home residents through medically unnecessary care and sending the bill to Medicare.

The businessman ran a network of assisted living facilities and nursing homes in Florida. Again and again, he bribed doctors to admit patients to his facilities and administer unnecessary medical services.

Esformes lived a life of luxury until he was arrested in 2016. This past April, he was found guilty on 20 counts involving money laundering, bribery and conspiracy. While his sentencing hasn’t been scheduled, he may be facing decades in prison.

Esformes Defrauded the Government to Fund His Lavish Lifestyle

Esformes personally made about $37 million from his scheme, using this wealth to fund his lavish lifestyle. With taxpayer money, Esformes spent $2.4 million leasing luxury cars and $2.1 million traveling in private jets. He bought watches costing $360,000 to $600,000 and paid over $8.9 million in credit card bills.

Esformes even used the fraudulent Medicare money to bribe his son, Morris, into an Ivy League school.

Jerome Allen, a former University of Pennsylvania basketball coach, confessed that Esformes paid him to qualify Morris as a recruited basketball player. Allen lied to the university and got Morris on the short list of eligible basketball players, and Morris was accepted into Penn and the University’s exclusive business school, Wharton. Allen testified that Morris would not have been accepted to the school if it weren’t for the bribe.

Esformes paid Allen about $75,000 in cash and another $220,000 through wire transfers over 2 years.

Convicted on Conspiracy, Bribery and Money Laundering

A federal jury found Esformes guilty of 20 separate charges related to bribery, money laundering and criminal conspiracy to defraud the United States. Although he hasn’t yet received a sentence, Esformes is facing lengthy prison time.

Esformes was convicted on several counts of paying kickbacks to doctors for referring patients to his nursing homes. He also bribed regulators to tell him when his facilities would be inspected—this allowed Esformes to hide the conditions of his nursing homes from authorities.

Esformes was also convicted for taking bribes from other healthcare providers, including home service labs, therapy providers, nursing companies and mental health centers. In exchange for money, he gave them the business of his assisted living residents. These providers also performed medically unnecessary treatments billed to Medicare.

Esformes was further convicted on obstruction of justice for plotting to help one of his co-conspirators leave the country. He was also found guilty of nine counts of money laundering as he funneled a large portion of the Medicare money to himself.

Esformes’s co-conspirators faced serious charges for their role in the Medicare scheme as well.

One of his co-conspirators was a physician’s assistant named Arnaldo Carmouze. He was charged with conspiracy to commit healthcare fraud. Carmouze signed medical documents and referrals for Esformes’s nursing homes, sometimes without meeting the patients at all.

Another co-conspirator, Odette Barcha, was convicted for conspiring to defraud the government. She was also found guilty of paying out and receiving kickbacks. Barcha paid doctors to move patients into Esformes’s facilities, disguising the payments as charitable donations.

Both Carmouze and Barcha pled guilty before the trial, leaving Esformes to face the jury alone. They were sentenced to prison time and ordered to pay a fine.

Medicare Fraud Hurts Nursing Home Residents

Medicare schemes hurt the government and taxpayers, but they also cause harm to nursing home residents. In frauds like this, nursing home residents are innocent victims used as pawns for profit. Instead of being treated with care and dignity, they are given treatments they don’t need and put into nursing homes unnecessarily.

These schemes waste patients’ time and submit them to potential nursing home abuse and neglect. Esformes’s nursing home residents faced inadequate care, poor conditions and lowered quality of life as they were cycled through his facilities. Plus, the fraud drained millions from the Medicare system that would have otherwise been used to provide care to people in need.

While Esformes and his co-conspirators have been brought to justice, Medicare fraud remains a common problem. If you or a loved one has been the victim of nursing home fraud or financial exploitation, contact Nursing Home Abuse Justice.

 

Sources:

“Man Who Bribed Son Into Penn Guilty in $1.3 Billion Health Fraud”. Bloomberg. Retrieved from https://www.bloomberg.com/news/articles/2019-04-05/man-who-bribed-son-into-penn-guilty-in-1-3-billion-health-fraud/ Accessed on May 10, 2019.

“Former hospital director, physician’s assistant plead guilty in $1 billion Esformes fraud case” McKnight’s Long-Term Care News. Retrieved from https://www.mcknights.com/news/former-hospital-director-physicians-assistant-plead-guilty-in-1-billion-esformes-fraud-scheme/. Accessed on May 10, 2019.

“South Florida Health Care Facility Owner Convicted for Role in Largest Health Care Fraud Scheme Ever Charged by The Department of Justice, Involving $1.3 Billion in Fraudulent Claims” U.S. Department of Justice. Retrieved from https://www.justice.gov/opa/pr/south-florida-health-care-facility-owner-convicted-role-largest-health-care-fraud-scheme-ever. Accessed on May 10, 2019.

“Jerome Allen admits Miami Beach businessman paid him bribes to get son into Penn” The Inquirer. Retrieved from https://www.philly.com/college-sports/jerome-allen-morris-esformes-penn-bribery-20190311.html. Accessed on May 10, 2019.

 

Author:Nursing Home Abuse Justice Team
Nursing Home Abuse Justice Team

Nursing Home Abuse Justice was founded to shine a light on nursing home and elder abuse. Every day, thousands of people in nursing homes and assisted living facilities are abused. Our team helps educate seniors and their loved ones on the common causes, signs and preventions of nursing home abuse. We report on real-world studies and current events from respected news outlets to expose this national problem.

Last modified: May 23, 2019