Three Individuals Indicted for Stealing $1 Billion from Medicare and Medicaid

Whistleblowers Are Urgently Needed to Stop this Type of Massive Fraud

The government has charged three individuals with a conspiracy to collect more than $1 Billion from Medicare and Medicaid for services that patients did not require or were not eligible to receive.  The three individuals are the owner of more than 30 nursing homes and assisted living facilities, a hospital administrator, and a physician’s assistant.

Yes, you read that correctly.  Three individuals are accused of stealing more than $1 Billion from Medicare and Medicaid.

According to the FBI, the three individuals were the leaders of a complex conspiracy that included filing false claims with the help of other healthcare providers, and an intricate money laundering scheme designed to hide the flow of payments and kickbacks.

The indictment charges that Philip Esformes operated a network of more than 30 nursing homes and assisted living facilities that provided services to thousands of patients.  Esformes and his co-conspirators allegedly billed Medicare and Medicaid for medically unnecessary services for many of these patients.  

The co-conspirators are also charged with receiving kickbacks in return for steering residents to other healthcare providers, who provided additional, medically unnecessary services.  The kickbacks allegedly were paid in cash or were disguised as payments for leases, services, or charitable donations to avoid discovery.

This case illustrates the critical importance of whistleblowers to uncover billions of dollars in healthcare fraud, waste, and abuse.  

The government receives millions of claims every day for reimbursement from Medicare, Medicaid, and other government healthcare programs.  The claims often set forth nothing more than the patient’s and provider’s identifying information, billing and diagnostic codes, an actual or electronic signature, and a request for payment.  Without help from a whistleblower on the inside, it is impossible for the government to determine whether the services were medically necessary, whether they were actually provided to the patients, or whether improper kickbacks were exchanged in return for patient referrals.

If you have evidence of Medicare or Medicaid fraud, it is your patriotic duty to come forward and stop the fraud.  In return, you are entitled to legal protections and a reward of up to 30% of the amount recovered by the government.  In Medicare and Medicaid fraud cases, it is not unusual for those rewards to reach millions of dollars.

To schedule a free and confidential consultation with an experienced whistleblower lawyer, call John Howley Esq. at (212) 601-2728.  Do not delay.  There are strict time limits and procedural requirements in order to qualify for a whistleblower reward.