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‘Largest’ Ever Medicare Fraud Scheme Busted At $1 Billion

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Ethan Barton Managing Editor

Three people were charged in a $1 billion Medicare fraud and money laundering scheme that federal authorities called “the largest single criminal health care fraud case ever,” the Department of Justice announced Friday.

“The owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator and a physician’s assistant were charged with conspiracy, obstruction, money laundering and health care fraud in connection with a $1 billion scheme,” a Justice Department statement said.

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

U.S. Attorney Wilfredo A. Ferrer added: “Medicare fraud has infected every facet of our health care system.” (RELATED: Feds Have No Idea What Medicare, Medicaid Fraud Costs)

Interestingly, the indictment was “unsealed,” the statement said, the Friday after a busy news week where major media has focused its attention on the Republican National Convention and business mogul Donald Trump’s presidential nomination.

Philip Esformes, 47, Odette Barcha, 49, and Arnaldo Carmouze, 56, all of Miami-Dade County, were charged for their alleged roles in the scheme. Esformes and his co-conspirators allegedly provided thousands of Medicare and Medicaid beneficiaries with skilled nursing home care or assisted living facilities, even though many did not qualify for such services.

The “beneficiaries received medically unnecessary services that were billed to Medicare and Medicaid,” the statement said.

The conspirators also allegedly took kickbacks and steered “these beneficiaries to other health care providers … who also performed medically unnecessary treatments that were billed to Medicare and Medicaid,” the statement said.

The indictment claims Esformes and his cohorts hid the bribes by disguising them as charitable donations and other payments.

“The indictment alleges that the co-conspirators accomplished this by employing sophisticated money laundering techniques in order to hide the scheme and Esformes’ identify from investigators,” the statement said.

Esformes and Barcha were also charged with obstructing the Justice Department’s investigation. Additionally, Esformes paid $15.4 million in 2006 for nearly identical conduct.

“However, Esformes and his co-conspirators allegedly continued this criminal activity-adapting their scheme to prevent detection and continue their fraud after the civil settlement,” the statement said.

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