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3 people charged in $1 billion health care fraud scheme

Suspects face fraud, money laundering charges

MIAMI – Three people from South Florida have been charged by the U.S. government for their alleged participation in a $1 billion scheme involving numerous numerous Miami-based health care providers.

Those arrested include the owner of more than 30 Miami-area skilled nursing and assisted-living facilities, Philip Esformes, 47; a hospital administrator, Odette Barcha, 49; and a physician's assistant, Arnaldo Carmouze, 56.

They are each charged with conspiracy, obstruction, money laundering and health care fraud.

"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," Assistant Attorney Leslie General Caldwell said.

According to an indictment, many of Esformes' clients did not qualify for skilled nursing home care or for placement in an ALF.

Prosecutors said 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. 

The trio is also accused of receiving kickbacks in order to steer the beneficiaries to other health care providers.

"Medicare fraud has infected every facet of our health care system," U.S. Attorney Wifredo A. Ferrer said. "As a result of our unrelenting efforts to combat these pernicious schemes, the Criminal Division, the U.S. Attorney's Office and our law enforcement partners continue to identify and prosecute the criminals who, driven by greed, steal from a program meant for our aged and informed to increase their personal wealth."

Esformes and Barcha are also charged with obstructing justice. 

According to the indictment, Guillermo and Gabriel Delgado were arrested in the scheme in 2014 and Esformes attempted to fund Guillermo Delgado's flight from the U.S. to avoid trial in Miami. 

Barcha is accused of creating sham medical director contracts after she received a grand jury subpoena in June 20, 2016, in order to conceal and disguise the payment of kickbacks she made in exchange for patient referrals for admission to Esformes Network facilities and another Miami-area hospital.

Prosecutors said Esformes paid $15.4 million in 2006 to resolve civil federal health care fraud claims made against him, but he and his co-conspirators continued their scheme.

Prosecutors said Barcha and Carmouze used sophisticated money laundering techniques to try to hide the scheme and Esformes' identity from investigators.