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The Largest Healthcare Fraud Scheme Ever Charged by the DOJ

The Largest Healthcare Fraud Scheme Ever Charged by DOJ

The U.S. Department of Justice (DOJ) recently announced a South Florida Healthcare Facility Owner was convicted for his role in the largest healthcare fraud scheme ever, involving $1.3 billion in fraudulent claims to Medicare and Medicaid for services that were either not provided, were not medically necessary or were procured through the payment of kickbacks.

"This largest-ever healthcare fraud conviction highlights the awful toll criminal schemes take on federal health programs," said HHS-OIG Special Agent in Charge Richmond. "Even beyond the vital dollars lost though, Esformes [facility owner] exploited and victimized patients by providing inadequate medical care and poor conditions in his nursing homes. Along with our law enforcement partners, we will continue the fight against such parasites."

Fraud took place between approximately January 1998 through July 2016

According to the DOJ's announcement the evidence showed that the facility owner led an extensive health care fraud conspiracy involving a network of assisted living facilities and skilled nursing facilities that he owned. He bribed physicians to admit patients into his facilities, and then cycled the patients through his facilities, where they often failed to receive appropriate medical services, or received medically unnecessary services, which were then billed to Medicare and Medicaid.

Additionally, the announcement mentions witnesses testified to the poor conditions in the facilities and the inadequate care patients received. He was able to conceal this from authorities by bribing an employee of a Florida state regulator for advance notice of surprise inspections scheduled to take place at his facilities. The evidence further showed that he used his criminal proceeds to make a series of extravagant purchases, including luxury automobiles and a $360,000 watch. He also used criminal proceeds to bribe the basketball coach at the University of Pennsylvania in exchange for his assistance in gaining admission for his son into the University. Altogether, the evidence established that the facility owner personally benefited from the fraud and received in excess of $37 million!

The facility owner also had two coconspirators, a physician's assistant, who previously pleaded guilty to conspiracy to commit healthcare fraud and is scheduled to be sentenced; and another individual who pleaded guilty to one count of conspiring to violate the anti-kickback statute - resulting in a 15-month prison sentence followed by three years of supervised release. She was also ordered to pay $704,516.00 in restitution.

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