U.S. charges three people in $1 billion Medicare fraud scheme

By Sarah N. Lynch

WASHINGTON (Reuters) – The U.S. Department of Justice unveiled its largest-ever criminal healthcare fraud case against individuals on Friday, charging the owner of Miami-based assisted living facilities and two others in a $1 billion scheme to swindle Medicare.

Prosecutors alleged that Philip Esformes, 47, “masterminded and executed a sophisticated health care fraud and money laundering” conspiracy that spanned more than a decade, according to court records.

Esformes and his alleged co-conspirators Odette Barcha, 49, and Arnaldo Carmouze, 56, are accused of steering patients who did not qualify for assisted living or skilled nursing into his network of facilities where they received medically unnecessary services that were billed to government healthcare programs.

The government also alleges that they solicited and extracted kickbacks from pharmacies, home health agencies and other providers.

The kickbacks were disguised as payments to escorts, to charities, and even to a basketball coach, among other things, according to a copy of the government’s request to detain Esformes.

Esformes plans to vigorously contest the charges, his lawyers said in a joint statement.

“Mr. Esformes is a respected and well regarded businessman. He is devoted to his family and his religion. The government allegations appear to come from people who were caught breaking the law and are now hoping to gain reduced sentences,” the attorneys, Michael Pasano and Marissel Descalzo, said.

This is not the first time Esformes has been in trouble with the law. In 2006, he paid $15.4 million to resolve civil federal healthcare fraud claims for what the government called “essentially identical conduct.”

To evade detection, the Justice Department said he and the other defendants adapted their strategy by employing “sophisticated money laundering techniques.”

The government also charged Esformes and Barcha with obstruction of justice, saying that Esformes tried to help another co-conspirator who was arrested in 2014 by paying for the person’s flight from Miami to escape the trial.

Barcha, meanwhile, created “sham medical director contracts” after receiving a grand jury subpoena, the Justice Department said.

Lawyers for Barcha and Carmouze could not immediately be identified.

(Additional reporting by Eric Walsh in Washington; Editing by Bill Rigby and Matthew Lewis)