Trial Begins February 11th in Largest Medicare Fraud Bust in US

The case involves American crooks, nursing homes, doctors, hospital workers, and over a billion in lost taxpayer dollars.

Editor: One of my readers is urging me to write something about American frauds, crooks and criminals so I’ve picked this news about a case the federal government says is its largest bust (so far). (Incidentally, the charity fraud posts like the one I wrote about yesterday are about Americans too!)

Today’s story is about former ‘one-percenter’ Philip Esformes and his father Rabbi Morris Esformes and their nursing home empire.

From the Miami Herald on Tuesday,

Once among the ‘1 percent,’ executive faces $1 billion Medicare fraud trial

 

Not long ago, Miami Beach executive Philip Esformes was living quite comfortably among America’s “1 percent,” raking in millions from his healthcare business, gobbling up pricey real estate and darting around the country in chartered jets.

Philip Esformes
Philip Esformes has been held behind bars since his arrest in July 2016.

Then, in a flash, his luxurious lifestyle went poof: FBI agents arrested Esformes in July 2016 and he suddenly became the poster boy for the biggest Medicare fraud case in the country. He was charged with bilking $1 billion out of the federal healthcare program for the elderly and disabled, while his vast business assets and bank accounts were frozen. Worse, Esformes, 50, was ordered held without bail at the Federal Detention Center in Miami.

Esformes was back in court Monday for one final hearing before he goes to trial by himself on Feb. 11. Once always tan and fit, he looked wan and frail as his defense team tried in vain to delay the start of trial. They sought more time to review the Justice Department’s long list of patients who prosecutors say received no services or medically unnecessary treatment at Esformes’ Miami-Dade chain of skilled-nursing and assisted-living facilities.

[….]

Esformes is standing trial alone because all of his co-conspirators have already pleaded guilty, including a physician’s assistant, Arnaldo Carmouze, and a former Larkin Community Hospital outpatient director, Odette Barcha. In January, both admitted that they recycled Medicare patients through the hospital and Esformes’ network of nursing homes and ALFs in an elaborate bribery scheme that prosecutors say was orchestrated by the healthcare executive.

Carmouze, 59, pleaded guilty to conspiring to defraud Medicare by accepting bribes for making patient referrals to Larkin and Esformes’ healthcare facilities. Barcha, 52, pleaded guilty to conspiring to pay bribes to physicians to refer patients to Larkin and receiving kickbacks herself to move patients into Esformes’ facilities.

Read the story, the list of charges is stunning, including this one:

Screenshot (860)
See a timeline of more than two decades of scams involving Philip and his father Rabbi Morris Esformes here: https://www.chicagotribune.com/news/watchdog/ct-esformes-timeline-met-20161002-story.html

Esformes is also accused of referring his own network of patients to convicted healthcare-fraud offenders, including Guillermo and Gabriel Delgado, who are serving prison time. The brothers admitted swindling Medicare for mental-health, prescription-drug, and home-healthcare services, and they ultimately helped federal investigators target the Miami Beach executive.

According to the indictment, the brothers paid some kickbacks for the patients by disguising them as payments for escort services for Esformes as well as related travel and hotel expenses.

Esformes was also charged with obstructing justice because prosecutors say he plotted in 2015 with the Delgado brothers to help one of them leave Miami for Israel to avoid trial.

More here.

For those interested in more on the cheaters, see this local news story from 2016 about divorce court proceedings where Philip’s ex-wife said he believed that “money is king.”

Accused wealthy fraudster’s alleged parenting style: ‘Money is king’

The federal Medicare Fraud Strike Force was involved in the extensive investigation.

question markAre you keeping tabs of loved ones in nursing homes? Are they receiving treatment they don’t need while the facility bills Medicare? Or are they perhaps keeping a rehab patient longer than is necessary simply to milk the system, a system that is predicted to be insolvent by 2026?

Imagine “Medicare for all” that the Dems continue to clamor for!

 

Is your Neighborhood Pharmacist a Crook?

Some are, but maybe not your local friendly, helpful health professional!

sessions and weed
You can bet the drug industry and the Medicare fraudsters were happy to see Sessions out as Attorney General

A little over six months ago, then Attorney General Jeff Sessions announced a major federal crackdown on doctors, pharmacists and other health providers for fueling the opioid crisis and using your Medicare and Medicaid dollars to line their pockets.

Here is a bit of one story about Sessions’ announcement.

From State News June 28, 2018:

Federal agencies on Thursday announced charges in what Attorney General Jeff Sessions called “the largest health care fraud takedown in American history,” an investigation into over $2 billion in alleged fraud by doctors, pharmacists, and nurses.

Many of the allegations centered on illegitimate opioid prescriptions. The Justice Department charged 162 defendants, including 76 doctors, for their roles dispensing opioids and narcotics, the result of investigations spanning 30 state Medicaid programs and numerous enforcement agencies.

[….]

“Some of our most trusted medical officials, professionals, look at their patients, vulnerable people suffering from addiction, and they see dollar signs,” Sessions said.

The alleged fraud and false billings collectively accounted for 13 million illegal opioid dosages, the Justice Department said, and also included 23 pharmacists and 19 nurses.

The Department of Health and Human Services also announced that since July 2017, it has excluded over 2,700 individuals and 587 providers from Medicare and Medicaid “for conduct related to opioid diversion and abuse” — including 67 doctors, 402 nurses, and 40 pharmacy services.

More here.

Here are a couple of more recent cases of Pharmacy fraud

Don’t miss my post from last week about Pharmacist Haytham “Tom” Fakih in Dearborn, Michigan.

Florida Fraudster

From a Justice Department Press release in December, here.

The owner of a Miami, Florida-area pharmacy who caused Medicare to pay more than $8.4 million over a six-year period for prescription drugs that were never provided to beneficiaries was sentenced today to 87 months in prison.

[….]

Antonio Perez Jr., 48, of Miami Beach, Florida, was sentenced by U.S. District Judge Federico A. Moreno of the Southern District of Florida, who also ordered Perez to pay $8,415,824 in restitution and to forfeit the same amount. Perez was ordered to forfeit four Miami-area properties worth approximately $700,000 and multiple bank accounts totaling over $250,000. Perez previously pleaded guilty to one count of conspiracy to commit health care fraud.

[….]

During the course of the scheme, Medicare paid Valles Pharmacy Discount over $32 million, of which at least $8.4 million was for prescription drugs that Valles Pharmacy never purchased and never provided to Medicare beneficiaries, Perez admitted.

 

ahktmar-pharmacy
The owner of Akhtamar Pharmacy will be sentenced in February.

 

California case

***Update*** Tatarian gets four years in the ‘big house.’  See here.

Also in December a federal jury found Pharmacist Tamar Tatarian, 39, of Pasadena, California guilty of a Medicare fraud scheme after she billed Medicare $1.3 million for drugs she never purchased or distributed.

You will be interested to see that she was one of those caught in Sessions’ big sweep earlier this year.

Tatarian, the owner of Akhtamar Pharmacy, will be sentenced next month.

 

question markSecret decoder ring at work!  Tatarian must be Armenian. See the Legend of Akhtamar.  My reference to Secret decoder ring comes from Ann Coulter’s ‘Adios America’ where she rightly points out that readers of news stories about crooks and criminals must search for clues about where the alleged perp might come from and how he/she got in to the country.
Exception!  See yesterday’s post about the Russians ripping off Washington staters! There the reporter actually says where those arrested were from.