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, has been found guilty on more than 20 charges, including bribery and paying kickbacks.
The decision in the case was announced Friday morning.
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” — including pharmacies, home health agencies, physician groups, therapy companies, partial hospitalization programs, laboratories and diagnostic companies — even though many of the services for which they were paid were not medically necessary or were never provided.
Esformes faced 26 charges overall, including conspiracy, obstruction, money laundering and healthcare fraud in connection with actions that culminated in what government officials said was “the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice” at the time of his being charged.
The jury, however, did not reach a verdict on the main count, that Esformes had conspired to defraud the Medicare program.
This is a developing story that McKnight’s Senior Living will be updating. See previous coverage of the case under Related Articles, below.