Three charged in $1 billion Medicare fraud scheme

According to the Department of Justice, the owner of more than 30 Miami-area skilled nursing and assisted living facilities, as well as two of his employees, has been charged with conspiracy, money laundering, and health-care fraud to the tune of $1 billion, in what is being called “the largest single criminal healthcare fraud cause ever brought about individuals.”

The indictment claims that with the help of a network of corrupt doctors and hospitals, 47-year-old Philip Esformes cycled thousands of Medicare and Medicaid beneficiaries through his Esformes Network facilities, despite that fact that they didn’t qualify.

Some of the treatments his network provided were harmful to patients. In some instances, drug addicts were prescribed opioids and other narcotics in order to entice them to stay in facilities where they didn’t belong.

According to authorities, Esformes and his co-conspirators also received kickbacks for directing referring patients to other community health care providers, including mental health centers. Once the patient reached their Medicare-imposed length of stay at one facility, the alleged fraudsters would move the patient to a different facility.

The massive scam helped Esformes, the extremely wealthy heath-care operator, fund a lifestyle that included private jets, a $600,000 watch and meetings with escorts.

Prosecutors say that Esformes faces a potential life sentence prison term under federal sentencing guidelines.

I’m suspicious of fraud, how can I help?

According to a report released by the Department of Health and Human Services in 2015, nursing homes regularly file claims for the highest, most expensive level of therapy, regardless of what the patients require. Do you suspect the government is being charged for services that are not being provided to your loved ones? Under the False Claims Act, a private citizen may sue an individual or a business that is defrauding the government, and recover funds on the government’s behalf. This particular practice is known as a Qui Tam lawsuit.

What is Qui Tam?

The Qui Tam provision of the False Claims Act is meant to encourage private citizens to come forward with information they may have about entities defrauding Federal programs, like Medicare and Medicaid, to allow the government a chance to recover stolen funds. The government may not have been aware of these acts being committed against them, therefore the whistleblower, or relator, is entitled to receive a financial reward for the service they provided to their country if litigation is successful. Often, this is a percentage of the recovery.

What The Carlson Law Firm can do for you

Here at The Carlson Law Firm, we have a team of dedicated and experienced professionals, including attorneys, nurses and investigators, many of whom are well-versed in the complex world of Nursing Home litigation. If you suspect the government is being falsely charged for services that are not being provided to your loved ones it is important that you contact an attorney immediately. Should you decide to proceed with a suit, often times, the relator reward depends on many factors, including the quality and detail of the work done on the case by the relator’s attorney. This is why it is vital you have a knowledgeable team behind you, every step of the way. Contact The Carlson Law Firm today for your free consultation.

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