South Florida Businessman Charged with $1 Billion Medicare Fraud

Miami Herald

In what seems to be the largest case of Medicare fraud in South Florida to date, a local businessman has been accused of $1 Billion in fraud spanning 14 years. Philip Esformes has pleaded not guilty to the following charges: conspiracy, obstruction, money laundering, and health care fraud. His alleged scheme involved numerous providers and individuals, some of which have already made deals in exchange for their testimony.

Esformes owns a network of nursing homes and assisted living facilities, which he used to receive Medicare payments for services rendered to patients who didn’t need them, or not rendered at all. Esformes and his co-defendants not only defrauded government health care programs directly, but they also received kickbacks for referring patients to other facilities involved in the scheme.

The case hit a snag last August when a judge decided that key evidence had been obtained illegally and was thus inadmissible. The evidence in question, boxes of documents pertaining to the scheme and a recorded conversation between Esformes and his co-conspirators, the Delgado brothers, became inadmissible on the basis of attorney-client privilege.

In his ruling, the judge, Alicia Otazo-Reyes, wrote, “Although the prosecution team operated in good faith, the execution of their duties was often sloppy, careless, clumsy, ineffective and clouded by their stubborn refusal to be sufficiently sensitive to issues impacting the attorney-client privilege.”  

The Miami Herald recently reported that District Judge Robert Scola disagreed with Otazo-Reyes’  ruling. However, the disagreement has lost relevance as the prosecution has decided against using the evidence. Esformes was arrested in 2016 and the trial, which has been pushed multiple times, is now set to start in January of 2019.

Medicare fraud is rampant in South Florida. With a growing community of retirees, South Florida is often used as an example for other districts dealing with fraud. The elderly are not the only victims, addicts in rehabilitation facilities are also targeted by fraudsters because they are equally vulnerable.

The average scheme is quite simple. It usually involves a small group of wrongdoers finding confidential information about Medicare beneficiaries in order to bill the program for unnecessary treatments, tests, and procedures. Today, Medicare fraud is a scourge costing taxpayers billions of dollars.

To prevent Medicare fraud, you should never give personal information over the phone, nor speak to door-to-door salesmen claiming to represent Medicare. You should always review your Medicare bills. If there is an error or questionable charges, you can contact the Medicaid fraud hotline.

Medicaid Fraud Hotline: 888.742.7248 or Report Online
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