Have You Been Injured? We're Ready to Fight for You.

Florida Medicare Fraud Case Is the Largest Ever Brought Against Individuals

Published on Aug 23, 2016 at 10:00 am in Nursing Home Abuse.

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.

Free Case Evaluation

At Thomas Law Offices, our personal injury attorneys recognize that our potential clients are likely going through some of the most difficult times of their lives. We don't want you to have to worry about paying out of pocket for legal advice when you're just starting to learn your legal rights and options. That's why we provide free case evaluations. We'll offer our expert advice about your potential case and walk you through how we can help you.

Call us or fill out the form below to tell us about your potential case and a personal injury lawyer will get back to you as quickly as possible.

Meet Our Founder

Tad Thomas - Trial Lawyer

Tad Thomas

Managing Partner

Tad Thomas has dedicated his practice to representing plaintiffs in various types of civil litigation, including personal injury, business litigation, class actions, and multi-district litigation.

After graduating with his law degree in 2000 from Salmon P. Chase College of Law at Northern Kentucky University, Mr. Thomas immediately opened his own private practice and began representing injury victims.

In 2011, Thomas Law Offices was established in Louisville, Kentucky. Over the past decade, Mr. Thomas has expanded his firm and now has offices in three additional locations: Cincinnati, Ohio, Columbia, Missouri, and Chicago, Illinois. He is also a frequent lecturer on topics like trial skills and ethics and technology.

Legal & Firm News

When Prior Authorization Leads to Harm Caused by Delayed Care

In March 2023, the American Medical Association (AMA) released the results of a survey conducted on the impact of health insurance prior authorization (PA) on patient care and outcomes. The survey results revealed shocking information about the extent to which health insurance companies control the type of medical care patients receive. At Thomas Law Offices, […]

Read More

How Do I Sue a Hospital for Medical Negligence?

Medical errors and other types of health care professional negligence have soared in recent years. Data recently published by the National Institutes for Health (NIH) shows that at least 251,000 patient deaths are estimated to be attributable to physician mistakes or other types of medical errors annually. Countless others fall ill or suffer injuries while […]

Read More

Ohio Car and Booster Seat Laws

According to the National Highway Traffic Safety Administration (NHTSA), traffic crashes are the leading cause of death and disability for children (aged 0-14) in the United States. But most of these deaths can be prevented. When we put our children in the car, we owe it to them to give them the safest experience possible. […]

Read More
Tad Thomas on The National Crime Victim Bar Association
National Civil Justice Institute - Trustee
Tad Thomas on Lawyer Minds
Tad Thomas on American Association for Justice
Southern Trial Lawyers Association
Illinois Trial Lawyers Association
Ohio Association for Justice
Kentucky Justice Association
Fellows of the Litigation Counsel of America
Martindale Hubbell Preeminent
2021 Public Justice Member
AAJ Masters of Trial Law: Champion