$1 bil­lion Medi­care fraud con­spir­acy al­leged in Mi­ami

Modern Healthcare - - REGIONAL NEWS - —Erica Te­ichert

The owner of more than 30 skilled­nurs­ing and as­sisted-liv­ing fa­cil­i­ties in the Mi­ami area and two co-con­spir­a­tors have been charged for their in­volve­ment in a $1 bil­lion Medi­care fraud and money laun­der­ing scheme, fed­eral prose­cu­tors said late last week.

The in­dict­ment marks the largest crim­i­nal health­care fraud brought against in­di­vid­u­als by the U.S. Jus­tice Depart­ment, ac­cord­ing to As­sis­tant At­tor­ney Gen­eral Les­lie Cald­well.

Ac­cord­ing to the in­dict­ment, Philip Es­formes, 47, ran the mas­sive scheme by billing Medi­care and Med­i­caid for med­i­cally un­nec­es­sary ser­vices pro­vided at his net­work of skilled-nurs­ing and as­sisted-liv­ing fa­cil­i­ties. Prose­cu­tors al­leged Es­formes and two oth­ers named in the in­dict­ment—hos­pi­tal ad­min­is­tra­tor Odette Bar­cha, 49, and physi­cian as­sis­tant Ar­naldo Car­mouze, 56—also re­ceived kick­backs for send­ing pa­tients to com­mu­nity men­tal health cen­ters, home health providers and other med­i­cal fa­cil­i­ties that par­tic­i­pated in the con­spir­acy.

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