WASHINGTON (dpa-AFX) - A South Florida health care facility owner has been convicted for his role in the largest health care fraud scheme ever charged by the Justice Department, involving over $1.3 billion in fraudulent claims.
Philip Esformes, 50, of Miami Beach, Florida, was convicted of multiple charges for making thousands of fraudulent claims to Medicare and Medicaid for services that were not provided, were not medically necessary or were procured through the payment of kickbacks, US investigators said Tuesday.
'Philip Esformes orchestrated one of the largest health care fraud schemes in U.S. history, defrauding Medicare and Medicaid to the tune of over a billion dollars,' said Assistant Attorney General Benczkowski.
The alleged scheme involved the provision of wrist, knee and other braces to elderly and/or disabled patients who did not need them, but who were covered by the Medicare public insurance system.
They were lured by an international telemarketing network involving call centers in the Philippines and Latin America.
The Department of Justice said that between January 1998 and July 2016, Esformes 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.
Esformes 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 Esformes received more than $37 million from the fraud.
His sentencing has not been scheduled.
Esformes's coconspirator Odette Barcha, who pleaded guilty, was sentenced to serve 15 months in prison followed by three years of supervised release. She was also ordered to pay $704,516.00 in restitution.
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