Florida: Facility Owner gets 20 Years for $1B Medicare Fraud

A federal district judge sentenced Philip Esformes, 50, a south Florida healthcare facility owner to 20 years in prison after being found guilty in the largest healthcare fraud scheme charged by the U.S. Justice Department. The case involves a decades-long scheme of kickbacks and money laundering in connection with fraudulent claims to Medicare and Medicaid for services deemed medically unnecessary. According to the evidence presented at trial, between January 1998 and July 2016, Esformes led an extensive healthcare fraud conspiracy involving a network of assisted living facilities and skilled nursing facilities he owned. Esformes bribed physicians to admit patients into his facilities. Then, he cycled the patients through his facilities where they often failed to receive appropriate medical services or received medically unnecessary services billed to Medicare and Medicaid. Several witnesses testified to the poor conditions in the facilities and the inadequate care patients receive. Esformes concealed the poor conditions and scheme from authorities by bribing an employee of a Florida state regulator for advance notice of surprise inspections scheduled to take place at his facilities. The evidence further showed Esformes used his criminal proceeds to make a series of extravagant purchases, including luxury automobiles and a $360,000 watch. Esformes also used criminal proceeds to bribe the basketball coach at the University of Pennsylvania in exchange for his assistance in gaining admission for his son into the university. Altogether, the evidence established that Esformes personally benefited from the fraud and received in excess of $37 million.

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