Advertisement
  1. News

Opening statements made in $1B Florida Medicare fraud case

A Florida health care executive used bribery, kickbacks and false paperwork in a $1 billion effort to fleece Medicare and Medicaid, one of the biggest such cases in U.S. history.
Published Feb. 12

MIAMI — A Florida health care executive used bribery, kickbacks and false paperwork in a $1 billion effort to fleece Medicare and Medicaid, one of the biggest such cases in U.S. history, a federal prosecutor told jurors Tuesday.

But an attorney for 50-year-old Philip Esformes told jurors as trial began in Miami that he was no criminal but a driven businessman who legitimately operated more than 20 nursing homes and assisted living facilities in Florida.

The opening statements kicked off a trial expected to last about eight weeks. Esformes faces decades in prison if convicted because of the scope of the alleged fraud committed between 2006 and 2016. There are also allegations that he bribed a college basketball coach in an effort to get one of his sons on the team.

Assistant U.S. Attorney Elizabeth Young told the jury the fraud involved four steps: bribing doctors to refer patients to Esformes' facilities, moving them to other facilities when their Medicare eligibility at the first place expired, selling access to patients to others so they could also defraud the government programs, and then starting the process again.

"I happened over and over and over again," Young said. "Rinse and repeat. And it happened for 10 years."

Prosecutors say the Esformes network and co-conspirators falsely billed Medicare alone for $1 billion during the scheme, of which about $500 million was paid. Much of the evidence relies on audio recordings between Esformes and two co-conspirators who were secretly cooperating with the FBI and have previously pleaded guilty, Young said.

"He was the mastermind. He made this happen. The evidence will show he was involved every step of the way," Young said.

Esformes attorney Roy Black, however, told jurors they should be skeptical of the motivations and backgrounds of many government witnesses, including convicted co-conspirators Gabriel and Guillermo Delgado.

"They have stacked their case with con artists, liars, fraudsters and even drug traffickers," Black said. "We will try to expose all that we can."

Black described many of the suspicious billings to government health programs as merely business disputes rather than fraud. In addition, Black said Esformes relied on medical professionals to decide what kind of treatment a Medicare or Medicaid patient needed.

"He is a businessman. He does not make medical decisions," Black said. "He doesn't diagnose people. He doesn't treat people. That requires doctors."

In one twist, former University of Pennsylvania basketball coach Jerome Allen pleaded guilty last year to accepting about $18,000 in bribes from Esformes in an effort to get one of his sons onto the Ivy League school's team.

Allen, now an assistant coach for the Boston Celtics who is cooperating in the Esformes case, faces a maximum of 10 years in prison when sentenced in March.

Esformes was also accused of paying a Florida health regulator $100,000 in bribes in return for tips about when inspectors planned surprise visits to his facilities and when patients made complaints.

A hospital administrator and a physician's assistant who were charged along with Esformes have pleaded guilty for their roles in the alleged scheme and may testify against Esformes.

ALSO IN THIS SECTION

  1. Tampa Mayor Jane Castor appears at a September forum on the Equal Rights Amendment at the Centre Club of Tampa. Her first budget was unanimously approved 7-0 by City Council. OCTAVIO JONES  |  Octavio Jones
    The mayor made some concessions in her $1.04 billion budget, especially to council member Orlando Gudes’ demands for East Tampa.
  2. Less than a month after being fired, former St. Petersburg Housing Authority CEO Tony Love wants the agency to give him a job running its development nonprofit at the same $157,000 salary. That offer, part of ongoing negotiations over his severance, was rejected by the agency's board.
    Tony Love’s attorney tells the agency that fired him he wants full salary and benefits through 2020. The board rejects his offer.
  3. John Jonchuck returned to a Pinellas County courtroom last month to attend a hearing about whether he was entitled to a new trial. A judge on Tuesday ruled that he is not. SCOTT KEELER  |   Times
    Jonchuck was convicted of first-degree murder in April. He dropped his 5-year-old daughter, Phoebe Jonchuck, off a bridge in 2015.
  4. Ralph Lewis Wald and wife Johnna Lynn Flores leave the Orient Road Jail on May 30, 2013, after Wald was acquitted in the fatal shooting of his wife's lover. [TIMES (2013)]  |  Tampa Bay Times
    An unidentified woman is found dead at their Brandon house. At the same time, the medical examiner confirms the wife has died.
  5. The Florida Department of Health in Hillsborough County identified a positive case of hepatitis A in a food service worker at Hamburger Mary's in Ybor City on Oct. 22, 2018. [JOSH FIALLO | Times] JOSH FIALLO | TIMES  |  JOSH FIALLO | Times
    Slightly more than 200,000 people have been vaccinated this year — a huge jump from the 49,324 people vaccinated in all of 2018.
  6. This satellite image shows Hurricane Michael on Oct. 9, 2018, as it enters the Gulf of Mexico. It made landfall near Mexico Beach in the Panhandle as a Category 5 storm. [Photo courtesy of NOAA] NOAA
    Nearly a year after the storm, 18,000 claims are still open.
  7. Falo Kane, 32, of Clearwater, faces four counts of sexual battery of a physically helpless person and a violation of probation charge, according to police. [CLEARWATER POLICE DEPARTMENT]  |  Clearwater Police Department
    There were four victims, police said. One was in a wheelchair and another was a disabled stroke patient. The accused wrote a letter of apology.
  8. An eighth-grade boy can be seen punching a seventh-grader in a locker room in this screenshot from a video taken inside a Polk County middle school. Twitter
    A black student was slammed to the floor and punched repeatedly by a white classmate following a physical education class last week at Blake Academy in Lakeland.
  9. Workers refuel the tank at a gas station in Jiddah, Saudi Arabia, Tuesday, Sept. 17, 2019. U.S. President Donald Trump declared Monday that it "looks" like Iran was behind the explosive attack on Saudi Arabian oil facilities. He stressed that military retaliation was not yet on the table in response to the strike against a key U.S. Mideast ally. AMR NABIL  |  AP
    Even before Tuesday’s reversal in prices, economists downplayed the prospect that the price spike could send the economy reeling.
  10. Watermans Crossing apartments at 4515 N. Rome Avenue in Tampa. Westside Capital Group
    Jakub Hejl discovered the Tampa Bay area while studying at IMG Academy.
Advertisement
Advertisement
Advertisement