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Catch of the Week – South Florida Health Care Facility Owner Sentenced to 20 Years in $1.3 Billion Fraud - The Largest Health Care Fraud Scheme Ever Charged by the DOJ

Posted  September 13, 2019

Philip Esformes, 50, of Miami Beach, Florida, was sentenced to 20 years in prison for his role in a decades-long billion-dollar scheme to submit fraudulent claims to Medicare and Medicaid both for services deemed medically unnecessary and services that were medically necessary but that he did not provide.  Esformes personally pocketed $37 million from this scheme to fund his lavish lifestyle, while leaving elderly and mental health patients with poor or non-existent care.

Esformes relied on paying and receiving kickbacks and bribes to cycle patients through his run-down nursing home and mental health facilities.  Several witnesses at trial testified to the shoddy medical conditions at the facilities.  To escape the government’s eye, Esformes bribed an employee of a Florida state regulator for advance notice of surprise inspections scheduled to take place at his facilities.  The facilities would be cleaned-up for the inspection and fall back to filthy and disorganized conditions immediately after.

In April 2019, after an eight-week jury trial, Esformes was found guilty of one count of conspiracy to defraud the United States, two counts of receipt of kickbacks in connection with a federal health care program, four counts of payment of kickbacks in connection with a federal health care program, one count of conspiracy to commit money laundering, nine counts of money laundering, two counts of conspiracy to commit federal program bribery and one count of obstruction of justice.  He will now head to prison for 20 years.

Assistant Attorney General Brian A. Benczkowski said, “[f]or nearly two decades, Philip Esformes bankrolled his lavish lifestyle with taxpayer dollars, paying bribes with impunity and robbing Medicare and Medicaid by billing for services that people did not need or get.”

Deputy Special Agent in Charge Denise M. Stemen of the FBI’s Miami Field Office added “Philip Esformes is a man driven by almost unbounded greed…he bribed doctors and regulators to advance his criminal conduct and even bribed a college official in exchange for gaining admission for his son to that university.”

At his sentencing, Esformes said “I’ve lost everything I love and cared about with the utmost intensity…[t]here is no one to blame but myself, me.”


Tagged in: Anti-Kickback and Stark, Catch of the Week, Criminal Proceedings, Healthcare Fraud, Lack of Medical Necessity, Medicaid, Medical Billing Fraud, Medicare, SNF,