$1 Billion Health Care Fraud Took Advantage Of Medicare In Florida, Agents Say

The Justice Department calls it the largest criminal health care fraud case ever brought against individual suspects: Three people are accused of orchestrating a massive fraud involving a number of Miami-based health care providers.

The three facing charges are all from Florida's Miami-Dade County; they include Philip Esformes, 47, owner of more than 30 Miami-area nursing and assisted living facilities; hospital administrator Odette Barcha, 49; and physician assistant Arnaldo Carmouze, 56, the Justice Department says.

"Medicare fraud has infected every facet of our health care system," U.S. Attorney Wifredo Ferrer said as indictments against the three were announced Friday.

The indictments accuse Esformes of leading "a complex and profitable health care fraud scheme that resulted in staggering losses — in excess of $1 billion," said Special Agent in Charge George L. Piro of the FBI's Miami field office.

Investigators say Esformes used his access to thousands of Medicare and Medicaid beneficiaries to perpetrate a fraud:

"Many of these beneficiaries did not qualify for skilled nursing home care or for placement in an assisted living facility; however, Esformes and his co-conspirators nevertheless admitted them to Esformes Network facilities where the beneficiaries received medically unnecessary services that were billed to Medicare and Medicaid."

More money was in play, investigators say, in the form of kickbacks Esformes and his co-conspirators received in return for "steering beneficiaries to other health care providers – including community mental health centers and home health care providers – who also performed medically unnecessary treatments that were billed to Medicare and Medicaid."

In addition to charges of conspiracy, money laundering and health care fraud, Esformes and Barcha were also charged with obstructing justice.