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At those facilities, prosecutors said, they also "received medically unnecessary services that were billed to Medicare and Medicaid," the huge government-run health programs that cover primarily senior citizens and the poor, respectively.
"Furthermore, Defendant [Esformes] and his co-conspirators preyed upon his beneficiaries addictions by providing them with narcotics so that the beneficiaries would remain in Esformes Network facilities, allowing the cycle of fraud [to] continue," prosecutors said in a court filing.
to enrich himself through false and fraudulent billings." Assistant Attorney General Leslie Caldwell of the Justice Department said: "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 as a tool in the ongoing fight against health-care fraud." South Florida is a hot spot for health-care billing fraud schemes that target the huge federal Medicare program, and the giant joint federal-state Medicaid program. Attorney Wifredo Ferrer said, "Medicare fraud has infected every facet of our health-care system." Prosecutors said Esformes faces a potential prison term of life imprisonment under federal sentencing guidelines.
As a result, the region has received special scrutiny from federal health regulators and prosecutors. In addition to Esformes, 49-year-old Odette Barcha, who had been director of outreach programs at Larkin Community Hospital, and physician's assistant Arnaldo Carmouze, 56, also were charged in the case and arrested early Friday morning.
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