DOJ Bust $1B Medicare Fraud Scheme

MIAMI — Three people are under arrest, charged in a $1 billion medicare fraud and money laundering scheme.

“This is the largest single criminal health care fraud case ever brought against individuals by the Department of Justice,” said Assistant Attorney General Caldwell in a statement released Friday.

Philip Esformes, an owner of more than 30 Miami-area skilled nursing and assisted living facilities, along with a hospital administrator and a physician’s assistant have been charged with conspiracy, obstruction, money laundering and health care fraud.

The indictment, unsealed Friday mentions Esformes, 47, Odette Barcha, 49, and Arnaldo Carmouze, 56, all of Miami-Dade County.

The government says Esformes masterminded the sophisticated and elaborate scheme. Through his facilities, he had access to thousands of people – elderly, homeless, addicts – covered by Medicare. The indictment alleges he and his partners in crime used the patients to shuffle them around needlessly from one place to another. They received unneeded medical services so Esformes and those working with him could file false Medicare claims.

Investigators point out while they bilked the government out of millions, at the end of the day, real people – these unwitting patients – are the living victims.

“Patients were not regarded as people, as living things but simply exploited as cogs in a machine of fraud,” said Special Agent Shimon Richmond.

Esformes and Barcha were also charged with obstructing justice. According to the indictment, Esformes attempted to fund an alleged co-conspirator’s flight out of the United States to avoid a trial in Miami.

The indictment also alleges the group used sophisticated money laundering techniques in order to hide the scheme and Esformes’ identify from investigators.

“These defendants wove together a network of corrupt doctors, hospitals and other health care fraud providers located all over South Florida in a conspiracy to cheat taxpayer dollars out of millions of dollars,” said Caldwell.

Besides the fraudulent medicare claims the government says Esformes, Barcha and Carmouze also got richer by getting kickbacks for unnecessarily referring patients to other health care providers including mental health centers and home health care providers.

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