Three charged in elaborate $1 billion fraud scheme

handcuffs

Three South Florida residents are facing criminal charges for orchestrating the largest healthcare fraud scheme to date, stealing $1 billion through an elaborate kickback scheme that funneled patients between various Miami healthcare facilities, according to the U.S. Attorney’s Office for the Southern District of Florida.

According to the indictment, Philip Esformes used a network of 20 skilled nursing and assisted living facilities throughout Miami to bill Medicare and Medicaid for medically unnecessary services by bribing providers at a local hospital. Esformes conspired with Odette Barcha, a consultant and director of outreach programs at a Miami hospital, and Arnaldo Carmouze, a physician’s assistant at the same hospital, which The Miami Herald identified as Larkin Community Hospital.

Esformes paid kickbacks to Carmouze and other medical professionals in exchange for referrals, while Barcha helped facilitate kickbacks between Esformes and Guillermo and Gabriel Delgado, two Miami brothers sentenced late last year for setting up sham consulting services.

Esformes maintained the scheme even after paying a $15.4 million settlement in 2006 to resolve claims that he unnecessarily admitted patients to a Miami hospital from one of his assisted living facilities. Following the settlement, Esformes and his co-conspirators adapted their approach, “employing sophisticated money laundering techniques” to hide the kickback payments and his identity.

Assistant Attorney General Leslie R. Caldwell called the scheme “ruthlessly efficient,” with conspirators using a network of corrupt providers to shuffle patients between various healthcare facilities while exchanging kickbacks disguised in various sham agreements.

“Unfortunately, South Florida remains ground zero for these types of scams, as today’s case illustrates,” she added.

According to the government’s motion for pretrial detention, secret recordings captured Esformes obstructing the case against the Delgado brothers by offering to fund Guillermo Delgado’s escape to Israel so Gabriel could “blame the empty chair” during the subsequent trial.

The recent charges add to the national fraud bust announced by the Department of Justice (DOJ) last month that captured more than 300 people with fraud schemes totaling more than $900 million. Federal investigators are focusing on the SNF industry following reports of unnecessarily high therapy levels among a high percentage of facilities.

- Here’s the U.S. Attorney’s Office release

- See the indictment

- Read Leslie Caldwell’s remarks

- Here’s the pre-trial detention motion

- Read The Miami Herald article