Trio Charged With Whopping $1B Medicare Fraud Scheme

Three Miami-Dade County residents were charged Friday morning for their roles in a $1 billion, 14-year Medicare fraud and money laundering scheme, the U.S. Attorney’s Office for the Southern District of Florida announced.

Philip Esformes, Odette Barcha and Arnaldo Carmouze are just the latest South Floridians to be charged with health care-related fraud, as Miami-Dade is known as hotbed of Medicare and Medicaid schemes. But this fraud tops all others.

“This is the largest single criminal health care fraud case ever brought against individuals by the Department of Justice,” Assistant Attorney General Leslie R. Caldwell said.

According to the indictment, the alleged scheme ran from 2002 through 2016, and involved submitting false and fraudulent claims to Medicare and Medicaid based on kickbacks and bribes, which resulted in about $1 billion in billings.

DOJ officials unveiled the charges in a press conference Friday morning. This follows a nationwide health care fraud bust in June, at the time the largest health care fraud takedown in U.S. history. That sting charged 301 individuals across the nation for their roles in schemes which resulted in $900 million in false billings.

One-third of those individuals were from the Southern District of Florida.

The Esformes, Barcha and Carmouze case involved 30 Miami nursing and assisted living facilities, according to the indictment. Esformes was allegedly the owner and/or operator of the 30 facilities, which included Adar Associates, Eden Gardens LLC, Lauderhill Manor LLC, Flamingo Park Manor LLC and La Serena Retirement Living LLC.

Barcha was the director of Barcha Consulting and a hospital outreach programs director, and Carmouze was a licensed physician’s assistant, according to the indictment. Four other co-conspirators were mentioned in the indictment, but not charged along with the trio.

The Esformes Network gave Esformes access to thousands of Medicare and Medicaid beneficiaries, and paid kickbacks to Carmouze and others for medically unnecessary referrals to his network, the indictment said. The charges were related to durable medical equipment and referrals for patients to Esformes’ facilities.

Carmouze allegedly signed the false and fabricated medical records and prescriptions .

Barcha allegedly received payment from Esformes’ shell company and cashed the checks to pay physicians for referrals to the Esformes Network. She also allegedly recruited physicians who worked at the hospital where she was an outreach director to refer patients to Esformes’ facilities.

The DOJ is seeking forfeiture of more than 30 bank accounts related to the alleged scheme, cars, 11 pieces of Miami-Dade property, two properties in Chicago and one in Los Angeles.

Attorneys for the defendants could not be reached for comment.

“Health care executives who exploit patients through medically unnecessary services and conspire to obstruct justice in order to boost their own profits – as alleged in this case – have no place in our health care system,” FBI special agent in charge Shimon Richmond said. “Such actions only strengthen our resolve to protect patients and the U.S. taxpayers.”


Source:  SFBJ

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