Three People Accused in Massive Medicare Fraud in Florida

The U.S. Justice Department is calling it the largest criminal health care fraud case ever brought against individual suspects. The $1 Billion health care fraud took advantage of Medicare in Florida, agents said.

Three people are accused of a massive fraud involving a number of Miami-based health care providers. Many assisted living facilities may also have been part of the health care fraud.

The three facing charges are all from Florida's Miami-Dade County; they are Philip Esformes, 47, owner of more than 30 Miami-area nursing and assisted living facilities; hospital administrator Odette Barcha, 49; and physician assistant Arnaldo Carmouze, 56, according to the Justice Department .

"Medicare fraud has infected every facet of our health care system," U.S. Attorney Wifredo Ferrer said Friday while indictments against the three were announced.

Included in the indictments are accusations of leading "a complex and profitable health care fraud scheme that resulted in staggering losses, in excess of $1 billion," said Special Agent in Charge George L. Piro of the FBI's Miami field office.

Community Mental Health Centers and Home Health Care Providers Received Payments

Investigators say Esformes access to thousands of Medicare and Medicaid beneficiaries were instrumental to perpetrate the fraud. How this will affect the future of Florida Medicare remains to be seen.

It was also announced that money, in the form of kickbacks, were paid to Esformes and his co-conspirators in return for "steering beneficiaries to other health care providers including community mental health centers and home health care providers, who also performed medically unnecessary treatments that were billed to Medicare and Medicaid."

"Many of these beneficiaries did not qualify for skilled nursing home care or for placement in an assisted living facility. However Esformes and his co-conspirators nevertheless admitted them to Esformes Network facilities where the beneficiaries received medically unnecessary services that were billed to Medicare and Medicaid."

Charges of conspiracy, money laundering and health care fraud against Esformes and Barcha were also included in the announcement.

According to one U.S. government source*, the average cost of long term senior care ranges from about $36,000 to around $72,000 per year. And in some cases the average can be over $250,000 per year. “Wow, what’s with the huge difference?” you may say.

That’s easy to answer. It is because there are 50 states in the U.S. and probably about 100 different Kinds of Long Term Care, or senior homes and senior living, depending on the state. Each of those different kinds of senior living has a different cost associated with it.

That’s right, the Kind of care and where it takes place makes a big difference in the yearly (and of course monthly) cost.

“The national median monthly rate for a one-bedroom unit in an assisted living facility is $3,500, according to the 2014 Cost of Care Survey released in April by Genworth Financial Inc. of Richmond, Virginia. That's $42,000 per year, an increase of 1.45 percent over 2013.”

And so the key to finding out ‘What is the Cost of Senior Home Living’ to you and your loved one is to have a good resource to help you

  1. Identify the kind of Senior Home you are in need of.
  2. Determine which of those homes can provide the kind of care required.
  3. Locate homes that fit and are close and convenient to you and your family.

Once you have that information, you can contact those homes to gain a good knowledge of the Cost of Senior Home Living for you and your loved one.

Senior Home Search is one of the Best Sources for helping you get this information. We offer information on thousands of small to medium sized Senior Care Homes across the U.S. in an easy to use format. Homes that are many times family owned and operated, fully state licensed, professionally staffed and very importantly, offer a family like home atmosphere.

There are literally dozens and dozens of web sites with “calculators” to get costs – and your name and phone number. There are web sites that pressure you to call an “800” number to talk to a sales person. But really, the best way is to use Senior Home Search to help you collect the information you need without the hassle. Contact Senior Care Home owners directly to find out what the Cost of Senior Home Living really is.

 

Start Your Search Now

 

*Source: U.S. Department of Health and Human Services

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