The Largest Single Criminal Health Care Fraud Case Ever Brought Against Individuals: $1 Billion Scheme Involving Miami-based Health Care Providers

The owner of more than 30 Miami-area skilled nursing and assisted living facilities, a hospital administrator and a physician’s assistant were charged with conspiracy, obstruction, money laundering and health care fraud in connection with a $1 billion scheme involving numerous Miami-based health care providers. 

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, US Attorney Wifredo Ferrer of the Southern District of Florida, Special Agent George Piro of the FBI’s Miami Field Office and Special Agent  Shimon Richmond of the HHS Office of Inspector General’s Miami Regional Office made the announcement.

“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,” said Assistant Attorney General Caldwell. 

Photo, right: Leslie R. Caldwell,  the Assistant Attorney General for the Criminal Division of the US Justice Department

“Medicare fraud has infected every facet of our health care system, said US Attorney Ferrer.  “As a result of our unrelenting efforts to combat these pernicious schemes, the Criminal Division, the US 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 infirmed to increase their personal wealth.”

“Esformes is alleged to have been at the top of a complex and profitable health care fraud scheme that resulted in staggering losses – in excess of $1 billion,” said Special Agent in Charge Piro.  “The investigators who unraveled this intricate scam are to be commended for their diligence and commitment to root out fraud within our health care system.”

“Health care executives who exploit patients through medically unnecessary services and conspire to obstruct justice in order to boost their own profits – as alleged in this case – have no place in our health care system,” said Special Agent in Charge Richmond.  “Such actions only strengthen our resolve to protect patients and the US taxpayers.”