Esformes, Sentenced to 20 Years, Refused Offer of 4-Year Reduction in Exchange for Admission of Guilt and Plans Appeal

Miami healthcare exec Esformes sentenced to 20 years in biggest Medicare fraud case

Philip Esformes, who once reigned over a healthcare kingdom that made him a super-rich man, was sentenced to 20 years in prison Thursday for paying bribes and receiving kickbacks in a massive $1 billion Medicare fraud case touted by federal prosecutors as the biggest in the nation.

U.S. District Judge Robert Scola said Esformes’ scheme to generate thousands of Medicare patients for his chain of assisted-living and nursing-home facilities in Miami-Dade was “unmatched in our community, if not our country.”

The judge said the taxpayer-funded Medicare program for the elderly and indigent was built on an honor system, and that “Mr. Esformes violated that trust in epic proportions.”

Before Scola issued his punishment, the wealthy Miami Beach business executive sobbed as he apologized to the judge. “I lost everything I loved,” Esformes, 50, said, admitting he was a “broken” man who was “disgusted” by his criminal activity. “I destroyed my marriage. I scarred my three children. There is no one to blame but myself. I accept responsibility for what I have done and regret it.”

Convicted at trial in April of 20 healthcare-related bribery, kickback and money-laundering charges, Esformes gave an emotional 16-minute speech that generally acknowledged his criminal life but also aimed for mercy. He has been held in the Miami federal detention center since his arrest three years ago.

“Your honor, I don’t want this [crime] to be the only legacy I leave behind,” said Esformes, whose lawyers and supporters in the courtroom spoke of his personal and financial charity, especially in the Jewish, medical and academic communities.

Justice Department prosecutor Allan Medina said Esformes not only exploited patients to line his pockets at his chain of 16 assisted-living and skilled-nursing facilities, but “corrupted” the whole Medicare system in his zeal to fill patient beds without providing actual care.

“He corrupted the entire system — the Medicare and Medicaid system,” Medina said. “Philip Esformes had every opportunity. He had wealth, [making] $78 million in 2017. … He has no excuse for what he did. He has no respect for the law. He has no remorse whatsoever.

“He was the boss,” Medina said. “He bullied people to get what he wanted.”

Justice Department prosecutors Medina, Elizabeth Young and James Hayes argued that Esformes had billed $1 billion to the federal health insurance program for questionable services that patients largely didn’t need or even receive between 2006 and 2016. For his sentencing, they estimated the government’s loss at more than $550 million and urged the judge to give Esformes 30 years in prison.

However, one of Esformes’ defense attorneys, Howard Srebnick, argued that the government’s estimated loss to Medicare was grossly inflated. He said the loss was as low as $690,000 and argued for a 10-year sentence.

Scola then cut Esformes a break, saying the loss was between $4.9 million and $8.3 million, which helped reduce the defendant’s potential sentence significantly. Scola called his estimate “highly conservative.”

At a critical juncture before he imposed Esformes’ punishment, the judge seemed willing to lower his final sentence by four years if the defendant agreed to elaborate on his “acceptance of responsibility” in his original statement to Scola. The judge said he would only acknowledge Esformes’ acceptance if he specifically admitted he paid bribes and committed other crimes. But, after Srebnick consulted with counsels Roy Black and Jackie Perczek, Esformes’ legal team chose not to go that route because it would have precluded their appeal of his trial convictions.

“There’s not much more Mr. Esformes will say today about his feelings and remorse,” Srebnick told the judge, arguing he has suffered greatly in federal detention, endured unending shame, and is no longer the arrogant man he was before his arrest.

After the sentencing hearing, Srebnick said Esformes plans to raise critical pre-trial allegations on appeal that had attacked how federal authorities obtained documents and recordings that led to the defendant’s indictment.

“For three years, the government alleged a $1 billion fraud, but today the district judge rejected that grossly exaggerated characterization,” Srebnick told the Miami Herald. “We are optimistic that the [federal] court of appeals will reinstate the magistrate judge’s findings of deplorable prosecutorial misconduct and will vacate the convictions and sentence.”

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Nursing Facilities and Long-Term Hospitals, Dangerously Weak Link in Healthcare – WHERE IS OVERSIGHT?

A Breeding Ground for a Fatal Scourge: Nursing Homes

Drug-resistant germs, including Candida auris, prey on severely ill patients in skilled nursing facilities, a problem sometimes amplified by poor care and low staffing.

Maria Davila lay mute in a nursing home bed, an anguished expression fixed to her face, as her husband stroked her withered hand. Ms. Davila, 65, suffers from a long list of ailments — respiratory failure, kidney disease, high blood pressure, an irregular heartbeat — and is kept alive by a gently beeping ventilator and a feeding tube.

Doctors recently added another diagnosis to her medical chart: Candida auris, a highly contagious, drug-resistant fungus that has infected nearly 800 people since it arrived in the United States four years ago, with half of patients dying within 90 days.

At least 38 other patients at Ms. Davila’s nursing home, Palm Gardens Center for Nursing and Rehabilitation in Brooklyn, have been infected with or carry C. auris, a germ so virulent and hard to eradicate that some facilities will not accept patients with it. Now, as they struggle to contain the pathogen, public health officials from cities, states and the federal government say that skilled nursing facilities like Palm Gardens are fueling its spread.

“They are the dark underbelly of drug-resistant infection,” said Dr. Tom Chiller, who heads the fungal division at the Centers for Disease Control and Prevention, speaking about skilled nursing facilities, particularly those with ventilated patients, but not Palm Gardens specifically.

Such nursing homes are playing a key role in the spread in New York, where 396 people are known to be infected and another 496 are carrying the germ without showing symptoms, according to public health officials. In Chicago, half of patients living on dedicated ventilator floors in the city’s skilled nursing homes are infected with or harboring C. auris on their bodies, said Dr. Allison Arwady, the acting commissioner of the city’s Department of Public Health.

Much of the blame for the rise of drug-resistant infections like C. auris, as well as efforts to combat them, has focused on the overuse of antibiotics in humans and livestock, and on hospital-acquired infections. But public health experts say that nursing facilities, and long-term hospitals, are a dangerously weak link in the health care system, often understaffed and ill-equipped to enforce rigorous infection control, yet continuously cycling infected patients, or those who carry the germ, into hospitals and back again.

They are caldrons that are constantly seeding and reseeding hospitals with increasingly dangerous bacteria,” said Betsy McCaughey, a former lieutenant governor of New York who leads the nonprofit Committee to Reduce Infection Deaths. “You’ll never protect hospital patients until the nursing homes are forced to clean up.”

[Read our other stories in our series on drug resistance, Deadly Germs, Lost Cures.]

The story is far bigger than one nursing home or one germ. Drug-resistant germs of all types thrive in such settings where severely ill and ventilated patients like Ms. Davila are prone to infection and often take multiple antibiotics, which can spur drug resistance. Resistant germs can then move from bed to bed, or from patient to family or staff, and then to hospitals and the public because of lax hygiene and poor staffing.

These issues have also vexed long-term, acute-care hospitals, where patients typically stay for a month or less before going to a skilled nursing home or a different facility.

A recent inquiry by the New York State Department of Health found that some long-term hospitals grappling with C. auris were failing to take basic measures, such as using disposable gowns and latex gloves, or to post warning signs outside the rooms of infected patients. At one unnamed facility, it said, “hand sanitizers were completely absent.”

Officials at the 240-bed Palm Gardens did not respond to repeated requests for comment. Over the past year, the number of patients who were infected with or were carrying C. auris there grew to 38 from six, according to a nurse there and public health officials. The tally has now fallen into the high 20s after some patients died or moved elsewhere.

The New York health department issued a statement in response to queries from The New York Times: “The Department of Health has made controlling the spread of C. auris a high priority and has conducted extensive training and education on infection control policies and procedures for Palm Gardens and other nursing home providers throughout this region. The health and well being of nursing home residents is our primary concern and we take complaints regarding quality of care very seriously.”

Scientific research on nursing homes and drug resistance is sparse, but some recent studies offer evidence of the problem. A study published in June in the Journal of Clinical Infectious Diseases found that patients and residents in long-term care settings have alarmingly high rates of drug-resistant colonization, which means they carry the germs on their skin or in their bodies, usually without knowing it, and can pass them invisibly to staff members, relatives or other patients. Elderly or severely ill people with weakened immune systems who carry the germ are at high risk of becoming infected. (Health officials in New York state said 14 percent of those now infected started out carrying it and then developed symptoms).

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The Nursing Home Business, Harming the Elderly and Most Vulnerable – Absolut and 1 Star, Oversight Needs Improvement

Orchard Park nursing home closing as owner files for bankruptcy protection

An Absolut nursing home in Orchard Park will close as its owner, Absolut Facilities Management, seeks Chapter 11 bankruptcy petition while it reorganizes, the company announced Wednesday.

Absolut did not announce a date for the closing of its Absolut Center for Nursing and Rehabilitation at Orchard Park, a 202-bed facility with about 185 residents.

The state Health Department on Wednesday approved a closure plan for the Absolut nursing home, said Jeffrey Hammond, a spokesman for the agency.

“The Department of Health will work to ensure that all residents have been placed in other facilities providing the appropriate levels of care, as required by the closure plan,” Hammond said.

The Health Department would not provide The Buffalo News on Wednesday with a copy of the closure plan it approved. Generally, the Health Department requires nursing homes that plan to close to continue operations until the last resident is relocated.

The Orchard Park nursing home is one of the lowest-rated nursing homes in Western New York. It has an overall rating of one star, or much below average, from the federal government. The nursing home has been cited by the Health Department for numerous deficiencies in recent years, but it has not been fined in the past three years.

Absolut, which operates a chain of nursing homes in New York State, and some of its subsidiaries filed for bankruptcy protection Tuesday in New York City, the company announced.

“These actions were taken in an effort to help the company financially reorganize itself and better position itself for the future,” the company said in a news release. “Similar to many other companies that have successfully utilized the Chapter 11 process to restructure their finances, the company expects to emerge from bankruptcy stronger than before.”

Absolut will keep open the company’s other nursing homes – in East Aurora, Gasport, Allegany, Painted Post and Westfield – as well as an assisted living facility in Orchard Park, the company announced.

Absolut’s seven facilities employs 975 people and generate revenues of $83 million, according to its bankruptcy filing. The Orchard Park facility that is scheduled to close has about 234 employees and recorded revenues of $18.1 million in 2018, down from $18.6 million the year before, according to the filing.

Absolut purchased the Orchard Park nursing home, along with other nursing homes in the Buffalo region, in 2007, beginning a wave of local nursing home purchases by investors from the New York City area.

In 2018, Absolut sold four other nursing homes in New York to Personal Healthcare, a downstate chain. Personal Healthcare was operating the former Absolut homes in Dunkirk, Eden, Houghton and Salamanca as it sought Health Department approval.

“As we have seen in recent days with the announcement of the closing of Newfane Hospital, health care generally, and specifically long-term care, faces significant challenges,” said Israel Sherman, CEO of Absolut Care. “We are very confident that we will emerge a much stronger company after these legal proceedings are concluded. It is our expectation that during this process that patient care, our employees and our commitment to excellence will remain our top priority.”

 

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More Than 200 Nursing Facilities in Bay Area Still Out of Compliance – [VIDEO]

Hollywood, Florida, Charges Filed in Nursing Home Deaths [Video] – Where is Oversight Before Tragedies?

W. Michigan – Nursing Care Deficiencies – Check the Ratings Before Placing Loved One in Nursing Facility [Video]

Nursing Home Abuse – Woman, 91, Terrorized [VIDEO] – Conditions at Nursing Homes and Oversight

 

The following is a review of the Abington of Glenview Nursing Facility:

Family sues Glenview nursing home over video of aides taunting woman, 91, with dementia; aides charged and fired

GLENVIEW, Ill. (WLS) — Two nursing home aides in north suburban Glenview have been fired and charged after a Snapchat video showed them taunting a 91-year-old woman with dementia.

Margaret Collins’ family is outraged, and taking legal action. The family’s lawsuit seeks more than $1 million in damages and alleges the nursing home, despite that video, turned a blind eye.

In the video Collins appears to be in distress, arms flailing as she pushes away a hospital gown.

“She’s waving her arms because of one reason. She doesn’t have mobility to get away. That’s the only option she has to protect herself,” said Tom Collins, her son.

Collins’ family said the great grandmother has dementia, and was known by workers at the Abington nursing home of Glenview to dislike hospital gowns.

The video of the encounter, four days before Christmas, was posted to Snapchat with the caption “Margaret hates gowns” and two laughing face emojis.

“You’re just like, this is somebody’s sick idea of entertainment?” said Joan Biebel, daughter.

The family is now suing the Abington and the two nursing assistants, Brayan Cortez and Jamie Montesa. Cortez and Montesa are also charged with misdemeanor disorderly conduct.

“Margaret’s privacy was clearly violated,” said John Perconti, attorney for the family. “They had no right to have cell phones in there.”

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