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U.S. charges 3 in $1 billion Miami-based Medicare fraud case

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(Bloomberg) — The Justice Department charged three Florida health care executives for allegedly carrying out a $1 billion Medicare scam involving numerous Miami-based medical providers.

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

Philip Esformes, owner of a chain of more than 30 Miami-area skilled nursing and assisted living facilities, allegedly conspired with two other people to defraud Medicare by providing medically unnecessary services to people, according to a 34-page indictment released Friday.

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“Esformes and his co-conspirators are also alleged to have further enriched themselves by receiving kickbacks in order to steer these beneficiaries to other health care providers,” the Justice Department said. “In order to hide the kickbacks from law enforcement, these kickbacks were often paid in cash, or were disguised as payments to charitable donations, payments for services and sham lease payments.”

Allegations denied

Esformes “adamantly denies these allegations and will fight hard to clear his name,” his lawyer, Marissel Descalzo, said in an e-mail.

“Mr. Esformes is a respected and well regarded businessman,” said Descalzo of Carlton Fields Jorden Burt PA in Miami. “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.”

In an unusual move, the Justice Department requested that Esformes be held pending trial, saying he is a flight risk.

“Due to the enormous loss from his criminal activities, he faces a potential term of life imprisonment,” the department said in a 78-page motion. Esformes “has already demonstrated that he would consider fleeing in the face of criminal charges.”


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