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Feds break $1 billion Miami health care fraud ring

July 27, 2016 by  
Filed under Blog

Attorney General Pam Bondi on Monday announced the arrests of three Miami-Dade residents on felony charges of operating a $1 billion fraud scheme involving Medicaid, Medicare and various Miami-based health care providers.

Bondi said her offices’ Medicaid Fraud Control Unit, working with federal agencies, charged Odette Barcha, 49; Arnaldo Carmouze, 56; and Philip Esformes, 47, with conspiracy, obstruction, money laundering and health care fraud. Bondi said her agency identified more than $100 million in fraudulent Medicaid charges connected to the scheme.

The indictment alleged that Esformes operated a network of more than 30 skilled nursing homes and assisted living facilities with thousands of Medicaid and Medicare beneficiaries, many of whom did not qualify for those benefits. According to Bondi’s office, “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.”

The probe also involved the FBI, U.S. Department of Health and Human Services Office of Inspector General and the U.S. Attorney in Miami.

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