$1 Billion Skilled Nursing Fraud Case Ends in 20 Guilty Verdicts

A nearly two-year-long case involving close to $1 billion in fraudulent Medicare and Medicaid billings came to a close this week with a slew of guilty verdicts in a Miami courtroom.

A 12-person jury found former skilled nursing and assisted living executive Philip Esformes guilty of 20 charges, the Miami Herald and other sources reported Friday; Esformes faced a total of 26 charges, with the jury deadlocking on several others.

The jury convicted Esformes on a host of bribery and kickback counts, and the 50-year-old could spend the rest of his life in prison, according to the Herald. Curiously, though, the jury could not reach a verdict on the federal government’s main charge of conspiracy to defraud the Medicare program, with the Herald speculating that some jurors possibly believed a line of argument that because Esformes did indeed provide some health services, he did not technically defraud the government.

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The Justice Department praised the jury’s ruling in a statement to the Herald.

“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,” assistant attorney general Brian Benczkowski told the paper. “I commend our dedicated prosecutors and law enforcement partners for their professionalism and unyielding pursuit of justice on behalf of American taxpayers and vulnerable beneficiaries who, as a result of Esformes’s crimes, were denied the level of care that they needed and deserved.”

Upon Esformes’s original arrest in July 2016, the DOJ accused the Esformes Network of SNFs and assisted living facilities of accepting residents who did not qualify for skilled nursing care, and also referring patients to other providers — including home health agencies and mental health facilities — in exchange for kickbacks.

“This is the largest single criminal health care fraud case ever brought against individuals by the Department of Justice, and this is further evidence of how successful data-driven law enforcement has been in the ongoing fight against health care fraud,” assistant attorney general Leslie Caldwell said in a statement back in July 2016.

Esformes’s case garnered national attention for both the scale of the fraud and the former operator’s flashy lifestyle, with the Herald noting his Ferrari and “pricey real estate” in Miami Beach.

The $1 billion case against Esformes wasn’t his first brush with federal regulators: Esformes, his family, and South Miami’s Larkin Hospital in 2006 paid a $15.4 million settlement to the Justice Department over accusations that they had “recycled patients” between the hospital and the Esformes assisted living facilities, according to the Herald.

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