An elaborate network of Florida nursing facilities reportedly were successful in scamming Medicare and Medicaid programs out of $1 billion over the last 14 years.
According to The New York Times, the case involves bribes to doctors in Miami, hush money paid to witnesses and gigantic sums paid to shell companies. The Medicare black market has reportedly ballooned in the last 10 years, creating an atmosphere in which nursing home residents were put at great risk by the fact that they were often shoved in and out of the system when it often wasn’t necessary and getting services they often did not need.
The Times reported that doctors, pharmacists and medical personnel got kickbacks and billed Medicaid and Medicare for expensive drugs, procedures and health equipment that patients either didn’t receive or didn’t need.
Federal prosecutors with the U.S. Justice Department went so far as to say that the accused “mastermind” behind the scheme “preyed upon” elder residents of nursing homes, sometimes pumping them with powerful and addictive medications so that they would be forced to stay longer in those facilities to receive treatment for their addiction.
They have called this, “The largest Medicare fraud scheme in U.S. history.” The owner of these facilities, 47-year-old Philip Esformes, oversees about 20 skilled nursing and assisted living facilities in the Miami region.
Esformes reportedly personally took home $78 million over the course of the last 14 years, including one year taking home more than $10.5 million. This money was reportedly spent on luxury items such as a watch for $600,000, private jet leasing, trips with escorts in Orlando and chauffeured limousines.
Prosecutors say this case of Medicare fraud, while the largest they have ever discovered, is simply indicative of a much larger problem: Fraud that has infected the health care system. In particular as it relates to Orlando nursing home negligence, patients who are elderly and vulnerable are being victimized by savvy health care business networks that are preying on their inability to speak out on their own behalf.
What makes this case especially egregious is that Esformes reportedly already had an opportunity to walk away from criminal charges for these same actions back in 2006. That’s when, as overseer of nursing homes and assisted living facilities in both Florida and Illinois, he paid out nearly $15.5 million to settle a civil lawsuit filed by federal government officials over allegations of Medicare and Medicaid fraud in Miami. But prosecutors allege that he continued these practices even after that settlement agreement was reached.
Prosecutors say Esformes even went so far as to attempt to bribe an associate of his facing criminal charges in connection with all this to flee to Europe, rather than face trial, where evidence would have been presented that could be sued against Esformes.
Authorities are asking that Esformes be held without bail, arguing he is a flight risk. Esformes, through his defense attorney, staunchly denies the charges.
It should be pointed out that health care fraud does more than just deprive the taxpayers of money. It results in the corrosion of the quality of care that nursing home patients can expect. Patients’ rights are violated when they are forced to undergo procedures that are unnecessary or are given drugs they don’t need.
Call Freeman Injury Law — 1-800-561-7777 for a free appointment to discuss your rights. Now serving Orlando, West Palm Beach, Port St. Lucie and Fort Lauderdale.
U.S. Says Florida Network Defrauded Medicare and Medicaid of Over $1 Billion, July 22, 2016, By Eric Lichtblau, The New York Times
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