3 Charged in $1 Billion Medicare Fraud

In what the Department of Justice is calling the “largest single criminal health care fraud case against individuals ever,” three people were charged with attempting to defraud the Medicaid and Medicare programs out of more than $1 billion.

The indictment was filed in Florida against Philip Esformes, the owner of more than 30 assisted living and skilled nursing facilities, along with a physician’s assistant and a hospital administrator. Investigators claim wide-spread fraud that saw thousands of unqualified beneficiaries run through Esformes facilities.  With the help of unethical doctors and hospitals networks, patients were funneled to Esformes owned facilities where Medicaid and Medicare were illegally billed for thousands of unnecessary medical services. It is also alleged that the scam included providing beneficiaries with narcotic prescriptions to ensure return visits.

In addition to the fraudulent billing, the charges also included: money laundering, conspiracy, and obstruction. In 2006 Esformes was required to pay $15.4 million for similar health care fraud charges but authorities say he was able to get away with continuing his crimes through an intricate and wide-spread money laundering scheme. It is unknown at this time as to how many people received kick-backs for referring beneficiaries.