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Three charged in $1 billion Medicare fraud scheme

By Ed Adamczyk

MIAMI, July 22 (UPI) -- The Department of Justice indicted three people in a $1 billion Medicare fraud scheme involving dozens of healthcare facilities in the Miami area.

Philip Esformes, 47, Odette Barcha, 49, and Arnalo Carmouze, 56, were charged in the scheme announced Friday.

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The Justice Department indictment said Esformes operated a network of more than 30 skilled nursing homes and assisted living centers in the Miami area, and admitted Medicare and Medicaid beneficiaries to his facilities, despite their ineligibility. The patients allegedly received unnecessary services and Esformes and his co-conspirators then billed Medicare and Medicaid for the services services.

Barcha is a hospital administrator and Carmouze a physician's assistant.

The three allegedly received kickbacks to steer clients to other healthcare providers, including mental-health centers and home healthcare providers.

Barcha is accused of attempting to obtain patient referrals for admission to Esformes' facilities, and other Miami-area hospitals, by creating fake medical contracts.

Esformes and Barcha were also charged with obstructing justice, the indictment said. After the 2014 arrest of co-conspirators Guillermo and Gabriel Delgado, Esformes allegedly attempted to help Guillermo Delgado's attempt to avoid trial in Miami by helping pay for his departure from the United States.

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In 2006, Esformes paid $15.4 million to settle similar healthcare fraud claims. The indictment said those indicted developed a sophisticated money-laundering scheme in an attempt to better hide identities.

"Esformes is alleged to have been at the top of a complex and profitable healthcare fraud scheme that resulted in staggering losses -- in excess of $1 billion," said FBI Special Agent in Charge George Piro.

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