The US Attorney General Loretta Lynch is after the Medicaid fraudsters like flies on dead bodies. From the New York Times and a huge THANK YOU to Atty Lynch. Without prosecutions like these, our elders and disableds are at risk of the “target, medicate, isolate, drain the estate and cremate” scheme currently plaguing our probate guardianship courts, nursing homes and hospitals. This should send a huge message to the Illinois Atty Registration and Disciplinary Commission and Atty Jerome Larkin, Sharon Opryszek and Melissa Smart that such actions will not longer be tolerated and the feds know exactly what 18 USC 4 for misprison of felony and 18 USC 371 can be used for.
WASHINGTON — In the biggest health care fraud case the Justice Department has ever brought, prosecutors charged on Friday that the owner of a network of Florida nursing facilities orchestrated an elaborate scheme to defraud Medicareand Medicaid of more than $1 billion over the last 14 years.
The case, featuring allegations of bribes to Miami doctors, hush money to witnesses, and laundering of huge profits through shell companies, shone a light on a lucrative Medicare black market that has surfaced in the last decade.
“Medicare fraud has infected every facet of our health care system,” Wifredo A. Ferrer, the United States attorney in Miami, said Friday in announcing the indictments of the owner of the medical facilities, Philip Esformes, and two others.
Mr. Esformes’s lawyer said on Friday that the businessman, who runs about 30 health care facilities in Florida and other states, “strongly asserts his innocence.”
Prosecutors, however, described him as the “mastermind” of a conspiracy that cycled some 14,000 elderly people in and out of nursing homes and assisted-living facilities, whether they needed medical care or not.
With the help of doctors, pharmacists, health care consultants and other medical personnel who got kickbacks for their roles, the facilities billed Medicare and Medicaid for high-priced drugs, medical procedures and health equipment that the patients either did not need or never received, prosecutors said.
In some cases, they charged, Mr. Esformes’s operation “preyed upon” the elderly patients by giving them narcotics so that they would have to remain longer in the care facilities to treat their addictions and “the cycle of fraud could continue.”
The Justice Department charged that Mr. Esformes, 47, who owns homes in both Miami Beach and the Chicago area, profited handsomely from the ill-gotten proceeds.
He reported assets of $78 million two years ago, and he withdrew more than $4 million in cash over the years from his many banking accounts, using proceeds from the scheme to pay for a $600,000 watch, the leasing of private jets and chauffeured limousines, and periodic trips with escorts to a Ritz-Carlton Hotel in Orlando, prosecutors charged in Federal District Court in Miami.
The scheme produced “staggering losses in excess of $1 billion,” said George L. Piro, the special agent in charge of the F.B.I. office in Miami. Leslie R. Caldwell, who leads the Justice Department’s criminal division, said that the $1 billion in fraudulent billings made the prosecution the biggest that the department had ever brought against individuals in a health care case.
“This was a whole network of people scratching each other’s backs, paying kickbacks and giving each other referrals,” she said. “It shows what people can do when they’re determined to put their hand in the Medicare pot.”
The indictments refer to other unnamed participants accused of taking part in the billing scheme, including doctors and pharmacists, and Ms. Caldwell said the Justice Department was continuing its investigation to determine whether additional charges should be brought.
With evidence of Medicare fraud growing, federal officials have created “strike forces” in Miami and eight other locations in recent years to better identify and prosecute suspects. They have also turned more frequently to data analytics tools to look for red flags. The effort has led to charges against 2,900 people in the last decade, with the fraudulent billings totaling $10 billion.
Ms. Caldwell said that in prosecutions like the one in Miami, “we’re getting better at focusing on the worst of the worst.”
Mr. Esformes has faced legal scrutiny before in Florida and Illinois over the operations of his nursing and assisted-living facilities. In 2006, he and his partners agreed to pay $15.4 million to settle a civil lawsuit brought by federal officials over accusations of Medicare fraud in the Miami area.
But prosecutors charged in the indictment announced on Friday that he continued the fraudulent billings even after that settlement, using intermediaries, shell companies and money laundering operations to disguise the scheme.
He is also accused of trying to pay an associate, Guillermo Delgado, who was prosecuted earlier in the same investigation, to flee to Europe rather than stand trial.
Mr. Esformes is charged with health care fraud, paying and receiving kickbacks, obstruction of justice and other crimes, and prosecutors said he could face a life sentence if convicted. The Justice Department asked on Friday that he be held without bail because his wealth and history made him a risk to flee.
Michael Pasano, a Florida lawyer representing him, said in an email after the charges were announced that “Mr. Esformes is no flight risk and is anxious to get back to his family and to be working on defending against these charges.”
He said that Mr. Esformes asserts his innocence and “insists all billings related to his facilities are legitimate and appropriate.”
As for the details of his client’s lifestyle, he said that “we will not comment on unfair and spurious allegations,” and he added that the Justice Department’s “only purpose” in including them was “to taint and defame Mr. Esformes.”