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The Largest Healthcare Fraud Scheme Ever

October 19th, 2016

Kickback Scheme Nets $1 Billion

Three people connected with a Florida skilled nursing company have been charged as part of the biggest healthcare fraud bust in U.S. history.

Charges were filed against a hospital administrator, a physician assistant, and the owner of more than 30 Miami skilled nursing facilities (SNFs) and assisted living facilities for conspiracy, money laundering, and healthcare fraud.

Phillip Esformes, the owner of the SNFs and assisted living facilities, allegedly paid kickbacks to physicians and other medical professionals for referrals. Many of the Medicare and Medicaid patients who were admitted did not actually qualify, and may have received unnecessary care. He also is charged with paying kickbacks for patients who received unnecessary home healthcare and care at community mental health centers. The alleged kickbacks sometimes were paid in cash or disguised as a charitable donation or a sham lease payment. Esformes also allegedly used sham medical director contracts.

The Florida case is part of a larger Medicare Fraud Strike Force effort that charged more than 300 people with Medicare fraud totaling more than $900 million – the largest bust of its kind to date.