Florida healthcare executive was found guilty in one of the largest Medicare fraud cases in history.
Florida-based health care executive Philip Esformes was recently convicted on twenty criminal counts related to a $1 billion Medicare fraud scam. In one of the largest cases in U.S. history, jurors reached a partial verdict after four days of deliberation. They were undecided on six additional counts, but prosecutors accepted the verdict rather than send them back for further deliberations.
Esformes, 50, a wealthy Miami Beach businessman, operated a system of nursing homes and assisted living facilities in South Florida. He was found guilty of paying kickbacks to doctors and administrators so they would refer patients to his businesses. He was also convicted of charges of obstruction of justice related to helping one of his co-conspirators flee to another country.
The jury found Esformes guilty of “money laundering and of bribing a Florida health regulator to warn him when inspectors planned surprise visits to his facilities and when patients made complaints,” according to court records. They ultimately could not decide whether Esformes was guilty of some counts related to Medicare fraud conspiracy.
“Philip Esformes orchestrated one of the largest health care fraud schemes in U.S. history, defrauding Medicare and Medicaid to the tune of over a billion dollars,” Assistant Attorney General Brian A. Benczkowski said. “I commend our dedicated prosecutors and law enforcement partners for their professionalism and unyielding pursuit of justice on behalf of American taxpayers and vulnerable beneficiaries.”
Attorney Roy Black said the government attorneys “could not prove the main count in their case against Esformes — the conspiracy to commit health care fraud charge.” He also suggested prosecutors “inflated the amount of money involved.” Black said, “They have hyped this into astronomical terms since the beginning. It came back to bite them.”
Esformes has been behind bars since his arrest in 2016. According to prosecutors, his health care network and other co-conspirators billed Medicare and Medicaid $1 billion for fraudulent services between 2009 and 2016. The charges he was convicted of add up to more than 250 years in prison, but he is not likely to get the maximum sentence.
Some of co-conspirators testified against Esformes during the seven-week trial. The witnesses described how Esformes would direct them to pay doctors in cash, using code words like “fettuccine.” They indicated the purpose for the kickbacks was to fill facilities at full capacity. The scheme soon involved inflating invoices that accounted for kickbacks and bribes. A health regulator even said she was paid to provide a schedule of unannounced inspections to Esformes’ collaborators.
Esformes’ defense tried to discredit the witnesses, saying they were lying in order to get reduced sentences. The defense said the inflation of invoices may have seemed “sneaky,” but it was how Esformes’ co-conspirators would “square up with him” at the end of the month.
The conspirators said, however, the bribes “went both ways,” testifying “Esformes accepted kickbacks to offer other health care providers access to patients in his facilities and bill Medicare for services that were unnecessary or fake.” Some of the kickbacks were checks made to mistresses and basketball coaches that got Esformes’ son into the Wharton School of the University of Pennsylvania.