Jury selection began Monday for the trial of Philip Esformes, the owner of multiple Miami-area assisted living and skilled nursing facilities accused in 2016 of orchestrating a $1 billion healthcare fraud scheme.

Esformes has pleaded not guilty to charges of conspiracy, obstruction, money laundering and healthcare fraud and has been in jail since his arrest.

As McKnight’s Senior Living previously reported, the federal government in part alleged that Esformes would move skilled nursing residents to his assisted living facilities when they were at or near the end of Medicare’s 100-day post-hospital benefit period for skilled nursing. “After the required 60-day waiting period between consecutive admissions to an [sic] SNF, a physician or physician assistant would readmit the beneficiary to the hospital, re-initiating the cycle,” according to a federal motion.

Meanwhile, the government alleged, Esformes provided access to assisted living residents “for any healthcare provider willing to pay a kickback,” even though many of the services for which they were paid were not medically necessary or were never provided.

The Esformes investigation already has led to an almost five-year prison sentence for Bertha Blanco, a 30-year employee of the Agency for Health Care Administration, the agency that oversees the licensure of assisted living and skilled nursing facilities in Florida. Blanco was sentenced for accepting bribes in exchange for providing confidential information to operators, including Esformes.

Additionally, physician’s assistant Arnaldo Carmouze and former hospital outpatient director Odette Barcha pleaded guilty in January to participating in the scheme. Specifically, Carmouze pleaded guilty to conspiring to defraud Medicare by accepting bribes for making patient referrals to a hospital and to Esformes’ facilities, and Barcha pleaded guilty to conspiring to pay bribes to physicians to refer patients to the hospital and to receiving kickbacks to move patients into Esformes’ facilities.