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Three charged in $1 billion Medicare fraud scheme

The Justice Department has convicted three people who allegedly defrauded Medicare and Medicaid in a $1 billion scheme in Miami.

“This is the largest single criminal health care fraud case ever brought against individuals by the Department of Justice,” said Leslie R. Caldwell, Assistant Attorney General the department’s criminal division, in a statement issued Friday.

Philip Esformes, 47, allegedly led a scheme that referred Medicare and Medicaid beneficiaries who did not qualify to skilled nursing and assisted living facilities. Esformes owned 30 such facilities, giving him access to thousands of beneficiaries. Also charged in the scheme are hospital administrator Odette Barcha, 49, and physician’s assistant, Arnaldo Carmouze, 56.

The three also took kickbacks, disguised as charitable donations or paid in cash, for directing the beneficiaries to selected health care providers, including pharmacies, health care agencies and mental health centers, according to investigators.

Attorneys representing Esformes said he did nothing wrong.

“Mr. Esformes is a respected and well-regarded businessman. He is devoted to his family and his religion,” according to his lawyers’ statement, the Miami Herald reported. “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.”

Esformes has a history of conducting health care fraud–in 2006 he paid $15.4 million after civil federal health care fraud charges emerged, according to the Department of Justice. Since then, the agency said Esformes and others adapted their scheme so as to go undetected by law enforcement.

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