Attorney General Pam Bondi News Release
July 25, 2016
Contact: Whitney Ray
Phone: (850) 245-0150
Three Charged in Massive Medicaid and Medicare Fraud Scheme
TALLAHASSEE, Fla.—Attorney General Pam Bondi’s Medicaid Fraud Control Unit today announced the arrests of three individuals for operating a $1 billion Medicare and Medicaid fraud scheme involving numerous Miami-based health care providers. Attorney General Bondi’s MFCU, as part of the HEAT Strike Force, assisted in identifying more than $100 million of Medicaid fraud in connection to this scheme. Odette Barcha, 49, Arnaldo Carmouze, 56, and Philip Esformes, 47, all of Miami-Dade County, are charged with conspiracy, obstruction, money laundering and health care fraud.
“My Medicaid Fraud Control Unit worked tirelessly to investigate more than $100 million in fraudulent Medicaid charges connected to this scheme and thanks to great collaborative efforts with our federal partners, this billion-dollar fraud scheme has been stopped and those responsible will be held to account,” said Attorney General Bondi.
According to the indictment, Philip Esformes, 47, operated a network of more than 30 skilled nursing homes and assisted living facilities that gave access to thousands of Medicare and Medicaid beneficiaries. Many of these beneficiaries did not qualify for skilled nursing home care or for placement in an assisted living facility. However, Esformes and co-conspirators admitted the beneficiaries to Esformes Network facilities, and received medically unnecessary services billed to Medicare and Medicaid. The defendants also allegedly received kickbacks by steering the beneficiaries to other health care providers, including community mental health centers and home health care providers, who also performed medically unnecessary treatments billed to Medicare and Medicaid. In order to hide the kickbacks from law enforcement, the kickbacks were often paid in cash, or were disguised as payments to charitable donations, payments for services and sham lease payments.
The Federal Bureau of Investigation, the Florida MFCU and the U.S. Department of Health and Human Services Office of Inspector General investigated the case, which was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney's Office for the Southern District of Florida. The Criminal Division’s Fraud Section and the U.S. Attorney's Office for the Southern District of Florida are prosecuting the case.
Related court documents, complete charges and additional information may be found on the website of the District Court for the Southern District of Florida at FLSD.USCourts.gov or on Pacer.FLSD.USCourts.gov.
The Florida Attorney General's Medicaid Fraud Control Unit investigates and prosecutes providers that intentionally defraud the state's Medicaid program through fraudulent billing practices. Medicaid fraud essentially steals from Florida's taxpayers. From Jan. 2011 to the present, Attorney General Bondi's MFCU has obtained more than $500 million in settlements and judgments. Additionally, the MFCU investigates allegations of patient abuse, neglect, and exploitation in facilities receiving payments under the Medicaid program.