DOJ shuts down $1B Miami nursing home fraud scheme

Three Miami-area healthcare providers have been arrested in a fraud scheme allegedly involving more than $1 billion in false billing, kickbacks, money laundering, conspiracy and obstruction—the largest fraud case to date.

The complex crime triangle included Philip Esformes, the owner of 30 Florida nursing homes; Odette Barcha, a hospital administrator; and Arnaldo Carmouze, a physician assistant, according to the Department of Justice (DOJ) indictment.

Together, the trio are accused of steering Medicare and Medicaid beneficiaries into services they didn’t actually qualify for or need—including skilled nursing care, behavioral healthcare and home health. The co-conspirators then doubled down by paying each other kickbacks for referrals, usually paid in cash or disguised to avoid detection by local law enforcement.

Two of the accused are well known to Health and Human Services' fraud squads:  Esformes and Barcha were involved in an earlier healthcare fraud case involving similar activities in 2006, where Esformes paid $15.4 million in a settlement, the DOJ statement notes.

Topics: Executive Leadership , Medicare/Medicaid