Florida Medicare Fraud Case Is the Largest Ever Brought Against Individuals

Three Florida residents were recently charged in an alleged Medicare and money laundering scheme that has been referred to by the U.S. Justice Department as the “largest single criminal healthcare fraud case ever brought against individuals.” As reported by CNBC, the scheme has netted the conspirators a total sum of over $1 billion since 2009.

In an indictment that was filed July 22, 2016, it was revealed that Philip Esformes, owner of 30 Miami assisted living and skilled nursing facilities, as well as a hospital administrator and a physician’s assistant were charged with conspiracy, healthcare fraud, and money laundering. Esformes, 47, lived a personal lifestyle that included private jets worth $2.1 million, luxury vehicles worth $2.4 million, and watches that were worth more than $360,000 each.

Esformes and his conspirators allegedly cycled thousands of Medicare and Medicaid beneficiaries through his company, Esformes Network, despite the fact that those beneficiaries didn’t quality for such care. Unnecessary care was billed to those accounts then laundered. In the court filing, it was revealed that those beneficiaries were prescribed with—and then became addicted to—narcotics which forced the beneficiaries to remain in Esformes Network facilities.

The three convicted money launderers additionally allegedly received kickbacks in order to steer Medicare beneficiaries to other healthcare providers such as community mental health centers and home healthcare providers who performed medically unnecessary treatments. The kickbacks were hidden from law enforcement since they were paid in cash or disguised as payments to charitable donations or falsified service and lease payments.

Back in 2006, Esformes paid $15.4 million to resolve civil charges that were brought against him for federal healthcare claims for unnecessarily admitting patients from his assisted living facilities into a Miami hospital. Instead of putting a halt to his criminal activity, Esformes merely adapted his latest scheme to prevent detection and continued committing fraud. Now, state prosecutors say that Esformes potentially faces a life term in prison.

Taking Small Steps To Prevent Financial Elder Abuse

Despite the fact that a decent percentage of Medicare billing fraud schemes like this case take place in Florida due to the state’s joint federal-state Medicaid program, corruption of this nature takes place across the United States at a widespread level. Wifredo Ferrer, Miami U.S. Attorney, said in an interview that “Medicare fraud has infected every facet of our healthcare system.”

Medicare fraud, especially at levels this massive, does nothing but harm our loved ones who depend on government-aided healthcare programs like Medicare and Medicaid. When money is being illegally laundered away into someone’s personal pockets, our elderly population suffers. The worst part might be the fact that for many of the family members of the beneficiaries who were taken advantage of, they had no idea this was occurring.

When we place our loved ones into a skilled nursing home or assisted living facility, we trust that they will be given adequate levels of care in order to stay healthy and safe. We trust the opinions and judgement of the doctors and facility staff members. Unfortunately, these doctors and staff members aren’t always as honest as we expect them to be. One of our only options in this type of situation is to stay vigilant, keep a close eye on our loved ones, and always be aware of our legal rights.

If, for any reason, you believe that your loved one might be getting abused either financially or physically in a nursing home or long term care facility, you have every right to open a legal investigation. Medicare fraud is definitely a form of financial abuse and may affect your loved one physically and emotionally due to the possibility of unnecessary treatments, etc.

Pay close attention to your loved one’s finances and physical/emotional condition at all times. If any signs of any type of abuse appear, don’t hesitate to get in touch with us to find out your options. Thomas Law Offices is here to help. Contact our office to learn more.