SNF owner led record $1 billion Medicare fraud ring, authorities say
At the center of the storm is Philip Esformes, who is accused of illegally shuffling residents in and out of his facilities, even enticing drug addicts with illicit opioids to go where directed. Esformes, Odette Barcha and Arnaldo Carmouze were each indicted for conspiracy, obstruction, money laundering and healthcare fraud, federal prosecutors announced Fridaymorning.
“This is the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice, and this is further evidence of how successful data-driven law enforcement has been as a tool in the ongoing fight against healthcare fraud,” said Assistant Attorney General Leslie R. Caldwell (left) of the Justice Department’s Criminal Division.
The conspirators allegedly admitted unqualified individuals into Esformes’ skilled nursing and assisted living facilities and billed Medicare and Medicaid inappropriately for services, dating back to at least 2002. The trio also allegedly received kickbacks to send beneficiaries to mental health and home health care providers, who also allegedly performed medically unnecessary treatments. Kickbacks were hidden as charitable donations and sham lease payments, officials say.
Esformes, 47, is no stranger to authorities. He paid $15.4 million in 2006 to resolve civil federal healthcare fraud claims for “essentially identical conduct,” officials noted at a press conference Friday. The conspirators continued with more sophisticated means to launder money and at least temporarily hide Esformes’ identity from investigators, they added. Ultimately, advanced data analysis and forensic accounting techniques by the FBI and Office of Inspector General led to the unraveling of the alleged scheme, officials said.
Esformes defense attorneys Marissel Descalzo and Michael Pasano issued a statement Fridaydeclaring his innocence.
“Mr. Esformes is a respected and well-regarded businessman. He is devoted to his family and his religion,” the statement said. “The government allegations appear to come from people who were caught breaking the law and are now hoping to gain reduced sentences. Mr. Esformes adamantly denies these allegations and will fight hard to clear his name.”
Prosecutors filed papers Friday in an effort to detain Esformes before trial. His detention hearing is set for Aug. 1, according to the Miami Herald.
“The conspirators were ruthlessly efficient,” the Justice Department’s Caldwell said. They allegedly paid bribes and kickbacks to keep patients nearing Medicare stay limits rotating to other corrupt providers, she added (see government graphic at right).
“Among the thousands of people cycled through the fraudulent network were, for example, drug addicts who were allegedly prescribed opioids – including OxyContin and Fentanyl – and other narcotics in order to entice them to stay in facilities where they didn’t belong,” Caldwell said.
Esformes is charged with obstruction of justice for allegedly trying to fund another co-conspirator’s flight out of the United States so that he could avoid trial in Miami, authorities said. They claim he wrote numerous checks to help fly the individual to Israel.
In a separate case, Esformes and his father, Morris Esformes, agreed to pay $5 million to settle a federal whistleblower lawsuit just six days before it was to go to trial in 2013. They were charged with accepting a multi-million dollar kickback from pharmacy giant Omnicare in 2004. The kickback allegedly came as part of a $32 million payment for Total Pharmacy, which was partially owned by Philip Esformes. In exchange for the money, Omnicare secured pharmacy contracts with two dozen nursing homes affiliated with the Esformeses, the suit charged.
Exactly the same scheme found in Orange County CA. between hospitals in the area. Hoag Hospital, the newly privatized acute care facility, Shlomo Rechnitz’s Mesa Verde (that prescribed pain meds right before he was creatively transferred to Hoag that mysteriously disappeared, but that Medicare paid for without question), transferred to Kindred Hospital Westminster with an unnecessary tracheostomy which was purposely left in over 21 days to jack up remuneration and hold him captive, and finally the facility (Pacific Haven)whose Kindred employed doctor finally killed my Dad by reducing his blood pressure using black boxed, unnecessary antibiotic in the fluroquinalone group (not to be given to those with prolonged QT interval or naturally low blood pressure-both of which my Dad has), “he might be getting pneumonia” with unneeded tylenol to dehydrate. After he died, he was discovered after nearly a 2 week delay of his autopsy by Pacific Haven cooperative Omega Society to still have alcohol and Ritalin in his blood in “nontherapeutic” amounts. Of course that means they were once in therapeutic amounts. This was not reported to authorities by the new Regional Autopsy group because it was in nonthereutic amounts, even though he was flushed with enormous amounts of fluids at Pacific Haven after his kidneys failed, to wash him out. So much so, that while he was still alive, he was oozing fluids from every pore on his body, leaving him in a puddle at death. From A to Z this was a homicide coverup. And it was a RICO organised crime. Now we are being sued by Kindred Hospital for nonpayment of Dad’s illegal bill while he was in “captivity” at that hospital. They are now trying to assign the CEO of Kindred, Julie Meyer, to be the new trustee to handle my Dad’s probate (conflict of interest much?). They are also deposing my elderly 93 year old Mom in an attempt to assign a guardian to her and to remove her from the family. We can find no lawyer to go up against Kindred, and now we know why…it is a huge case of organised crime involving the most powerful people in Orange County. We finally filed murder charges after being told we couldn’t…since everyone is getting kickbacks it seems. My Dad left Hoag with a moderate amount of DRGs and the number exploded at Kindred. We can only assume his case was hung in the doctors’ lounge/office at Kindred, because he ended up having over 30 doctors seeing him (literally seeing him…leaning in the doorway and just looking at him followed by $180 to 250.00 bills for every doctor for every day he was there). Hundreds of thousands in doctor’s bills and millions in hospital bills. My Dad got Medi-Cal approved the day before he was murdered by Pacific Haven and we are still trying to get the cash back from them that my Mom paid back for months while awaiting approval. Even our lawyer seems to be part of the problem. This is not the way I had planned on spending my retirement, to be sure! My poor Mom is totally beaten up! We babyboomer kids are also elders in or 60s and 70s, so it is elder abuse on every level. I am hoping we can break up this evil bunch of scoundrels as well.
I am sooo sorry to hear this happened to you. I am going to make this a main post for today to show people the pervasivness of the problem. Prayers for you. Please fill out my corruption survey form at https://drive.google.com/open?id=0B6FbJzwtHocwMEZSNGpuTEFGQjA
I cannot believe it. These idiots are even getting into my phone now. I have tried to post my problem with your form which seems to be structured more for illegal guardianships. We beat one of these attempts and are just starting on the new assaults. I guess I will have to write more of a detailed narrative. We have a case number for our attempted murder/murder charges. I will have to get busy writing.
Just write what you need to and I can publish. So sorry this happened to you
Oh I’m sure morris esformes will be charged with plenty come this
Just waiting to see them string up Phillip and watch his ole man Morris die with a broken heart..Remember Esformes you reap what you sow and even the Jews have to meet their makers,like it or not!!
Many psychopaths steal and murder without guilt or remorse and use charitable donations as a mask. Its called grooming or preping for real crime. You dont think like they do if yr an empath. See my posts on the true mind of a psychopath. Watch some youtube videos on psychopaths. Get educated. The man is in jail ( or his son) for fraud in edocaid/ medicare of $1 billion. That ways enough. Go talk to ken ditkowsky and you will get an earful. Also joy ketelhut. She knows stuff.her mom was murdered at warren barr
I know the esformes and all the Jewish operators from years ago they are very sick people I had dealt with them over the years they would hold there nursing homes for ransom behind there charitys always yelling, screaming and making regular peoples lives trying to work just terrible ! They are finally getting what they deserve the hell they gave. Is the trial done ?
the trial now isn’t until december. I can check on pacer in november to make sure they haven’t reset the trial. date. I would love to hear about what you know of the esformes for the blog. either you can write something up or call me and I’d be glad to do it for you. thanks for your comment