Florida healthcare executive convicted in $1.3B Medicare, Medicaid fraud scheme 

File folders labeled "insurance," "fraud," "claims," and "under investigation"
The owner of several Florida health facilities has been found guilty for his role in a $1 billion fraud scheme. (Getty Images/Olivier Le Moal)

The owner of several South Florida skilled nursing and assisted living facilities has been found guilty for his role in a $1.3 billion scheme to defraud Medicare and Medicaid—one of the largest in U.S. history. 

Philip Esformes, 50, of Miami Beach, was convicted by a jury on 18 counts in the case, and sentencing has not been scheduled, according to an announcement from the Department of Justice (DOJ). 

Esformes was found guilty of leading an extensive fraud scheme from between January 1998 and July 2016, according to the DOJ. Esformes bribed physicians to refer patients to his nursing facilities, where they were given medically unnecessary care or inappropriate services that were then billed to Medicare and Medicaid. 

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Witnesses at the trial also testified about the poor state of the facilities owned by Esformes, according to DOJ, saying he was able to obscure the condition of these locations by bribing state regulators. 

“Philip Esformes is a man driven by an almost unbound greed,” Denise Stemen, assistant special agent in charge at the Federal Bureau of Investigations Miami, said in the announcement. “The illicit road Esformes took to satisfy his greediness led to over $800 million in fraudulent healthcare claims, the largest amount ever charged by the Department of Justice.” 

RELATED: OIG’s chief data officer explains how analytics uncovered a $1B fraud scheme 

Esformes personally gained about $37 million through the scheme. He used the money earned through the scheme to make several “extravagant” purchases, according to the DOJ, including luxury cars and a $360,000 watch. 

In addition, he also used some of the funds to bribe a basketball coach at the University of Pennsylvania to ensure his son’s admission to the school, the DOJ said. 

Other conspirators in the scheme pleaded guilty as well, according to the announcement. Arnaldo Carmouze, a physician assistant, pleaded guilty to his role in the scheme and is set to be sentenced April 10. 

Co-conspirator Odette Barcha was sentenced April 3 to serve 15 months in prison followed by three years of supervised release, according to the DOJ. She was also ordered to pay more than $704,000 in restitution. 

Shimon Richmond, special agent in charge at the Department of Health and Human Services Office of Inspector General’s Miami office, said in the announcement that the case “highlights the awful toll criminal schemes take on federal healthcare programs.” 

“Along with our law enforcement partners, we will continue the fight against such parasites,” Richmond said. 

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