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Coalition Against Insurance Fraud

Jury ready to debate alleged $1B Medicare scam in Florida

March 29, 2019, Miami, FL — Philip Esformes is the only defendant standing trial in the nation’s biggest Medicare fraud case, but the wealthy Miami Beach executive has been portrayed as if there were two of him — one dirty, one clean.

According to Justice Department prosecutors, Esformes ran his Miami-Dade chain of skilled-nursing and assisted-living facilities like a crime boss, billing close to $1 billion to the taxpayer-funded Medicare and Medicaid program for dubious services that patients largely didn’t need or even receive.

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Prosecutors put on a series of convicted healthcare associates, a former hospital director and an ex-Ivy League basketball coach to testify about how Esformes paid them and various doctors hundreds of thousands of dollars in bribes to buy and sell patients as well as to get his son into the University of Pennsylvania.

“Philip Esformes lied for money,” Justice Department lawyer Allan Medina said in a packed Miami federal courtroom during closing arguments Friday. “He cheated. He tried to take the easy way out. He tried to game the system everywhere he turned. ... In the end, $38 million filled his pockets as a result of the lies and the games he played.”

But Esformes’ defense team of high-priced lawyers also called a lineup of witnesses at trial, such as nurses, therapists and administrators who once worked for him. They testified about his hands-on management style, generosity of time and money, and devotion to his family and Jewish faith. They argued that his patients, whether coming out of hospital surgery or suffering from mental illness, received the care they needed in his facilities under Medicare and Medicaid coverage.

His principal defense lawyer, Roy Black, described Esformes as an “obsessive” businessman who never paid a single doctor for referring Medicare patients to his chain of facilities and never sold any of his patients to healthcare operators to bilk the federal insurance program for the elderly, disabled and poor.

Black said two healthcare associates working undercover for the feds recorded a series of conversations with Esformes, and he never talked about fleecing the federal program. “In those 40 hours ... they couldn’t get one piece of evidence that Philip Esformes was guilty of Medicare and Medicaid fraud,” Black told jurors, adding there was “nothing about paying doctors” and “nothing about kickbacks.”

Esformes’ fate will soon be in the hands of 12 Miami federal jurors, who received jury instructions from U.S. District Judge Robert Scola before closing arguments started Friday. Starting Monday, jurors must decide whether they accept the Justice Department’s portrayal of Esformes as a corrupt “mastermind” who bought and sold patients, or the defense’s version of him as a hard-working businessman who did everything by the book.

Jurors will have to weigh two months’ worth of evidence — undercover recordings, financial documents, text messages and testimony from convicted associates — in a case built mostly upon conspiracy charges involving healthcare fraud, paying and receiving kickbacks, money laundering, bribery and obstruction of justice.

Esformes, 50, who was arrested in July 2016 and has been held without bond at the federal detention center, could spend the rest of his life in prison or regain his liberty.

Even by the standards of Miami, the reputed capital of healthcare fraud in America, Esformes’ case sticks out for its sheer size. Esformes’ healthcare network was paid about $500 million by the Medicare program between 2010 and 2016, with the executive pocketing $38 million himself, a finance expert for the prosecution testified at trial. Before his assets were frozen, the Chicago transplant owned dozens of local healthcare businesses that billed $1 billion to Medicare and Medicaid over the past decade. Esformes, who went through a messy divorce, also acquired pricey real estate in Miami Beach and drove a Ferrari sports car.

According to the Justice Department’s indictment, Esformes exploited his network of 16 Miami-Dade skilled-nursing and ALFs to fleece the Medicare and Medicaid program by filing false claims for services that were not necessary or not provided over the decade leading up to his arrest.

Larkin Hospital in South Miami referred some of the thousands of Medicare patients to Esformes’ network as a result of bribery payments that he made to physicians and other medical professionals, according to trial evidence.

Esformes is also accused of referring his own network of patients to convicted healthcare-fraud offende

Source: Miami Herald

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