DOJ charges 3 people for $1B Medicare fraud scheme

The Department of Justice charged a hospital administrator, physician's assistant and owner of more than 30 Miami-based nursing and assisted living facilities in connection with a $1 billion Medicare fraud and money laundering scheme in an indictment unsealed Friday.

Operator Philip Esformes, 47, administrator Odette Barcha, 49, and nurse practitioner Arnaldo Carmouze, 56, were each charged. All are residents of Florida's Miami-DadeCounty.

According to the indictment, Mr. Esformes was allegedly responsible for operating a network of over 30 skilled nursing homes and assisted living facilities across Miami called the Esformes Network. The government claims Mr. Esformes and his co-conspirators admitted numerous Medicare and Medicaid beneficiaries to the facilities, even if they did not qualify for home care, and provided numerous medically unnecessary services that were subsequently billed to Medicare and Medicaid.

The indictment states that Mr. Esformes and his accomplices allegedly received additional kickbacks for sending beneficiaries to other healthcare providers who also performed medically unnecessary procedures and billed those services to Medicare and Medicaid.

Mr. Esformes and Ms. Barcha were also charged with obstructing justice. After the arrest of two of his co-conspirators in 2014, Mr. Esformes attempted to fund the escape of one of the abettors to help him avoid trial in Miami, the indictment states. The indictment also stated that Mr. Esformes and his accomplices allegedly continued with their scheme by adapting their prevention detection and money laundering techniques to hide their activities from investigators.

"This is the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice, and this is further evidence of how successful data-driven law enforcement has been as a tool in the ongoing fight against health care fraud," said Assistant Attorney General Caldwell. 

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