Physician assistant admits role in $1B Medicare fraud scheme

A former physician assistant faces up to 10 years in prison after pleading guilty in Florida federal court Jan. 9 to his role in a $1 billion Medicare fraud scheme.

Four things to know:

1. Arnaldo Carmouze, who pleaded guilty to one count of conspiracy to commit healthcare fraud, was one of three defendants charged in an indictment unsealed in July 2016.

2. According to the indictment, Philip Esformes operated a network of more than 30 skilled nursing homes and assisted living facilities in Florida. Prosecutors alleged he and his co-conspirators, including Mr. Carmouze, admitted many Medicare and Medicaid beneficiaries to the facilities, even if they did not qualify for skilled nursing home care or for placement in an assisted living facility. Once admitted, the patients received medically unnecessary care that was billed to Medicare and Medicaid.

3. Mr. Esformes and his co-conspirators also allegedly steered patients to other healthcare providers in exchange for kickbacks. Those providers also performed medically unnecessary treatments that were billed to Medicare and Medicaid, according to the DOJ.

4. Mr. Carmouze's sentencing is scheduled for March 20. In addition to the prison term of up to 10 years, he faces a fine of up to $250,000 and up to three years of supervised release.

More articles on legal and regulatory issues:

West Virginia hospital, CEO hit with federal kickback suit
Owner of medical equipment company sentenced to 3 years for billing fraud
Former Cleveland Clinic executive gets prison time in $2.7M fraud scheme

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