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

In 2016, then-U.S. Attorney Wifredo Ferrer announced a $1 billion Medicare fraud case against Miami Beach healthcare executive Philip Esformes and others at a news conference.

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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Tish James and the GOP…. and then There’s Aron Wieder, Ms. James Have You Ever Spoken to Concerned Rocklanders?

AG James, the video may seem disturbing, but perhaps you have not considered what is REALLY Happening in Rockland County. Allying with Aron Wieder is Almost an Oxymoron, and Supporting his Political Allies in Rockland is Degrading the Views of Those Who Have Legitimate Concerns, Whether GOP or Otherwise…

Just an Opinion

Tish James and GOP Video

It should be noted for the reading public that as far as LM is aware, AG James has NEVER come to Rockland County, New York and sat with the secular and non-Jewish community to get their take on events in Rockland County, which is largely a democratic county many of whom are in agreement with the GOP on these points. She has, however, visited with the ultra-Orthodox, as she was campaigning.

AG James has, most likely, not taken a look at the tax registers in Rockland County to see just how many houses in Rockland County are listed as LLC owned with numerous LLC’s registered to the same addresses, some of which are for-profit and some non-for-profit (church (synagogue) based so reduced reporting requirements and reduced taxes) and how much that situation (reduced taxes paid by those homes) is costing taxpayers in Rockland County.

AG James has NEVER taken a moment to consider the battle between those like Aron Wieder who favor religious education absent secular interference but who still demand funds from the State to pay for that education. To his credit Wieder did allegedly work to get his community vaccinated; but most of that community is still comprised of anti-vaxxers costing County taxpayers thousands if not hundreds of thousands in unnecessary healthcare costs, whether related to the measles outbreak or otherwise.

AG James has oversimplified a problem. If she really wants to benefit the communities of Rockland (everyone, not just the Democrats and more particularly the ultra-Orthodox who funded her campaign), which is a melting pot of many religious (including Jews who are not Hasidic), she should focus on the crime and corruption within Rockland.

The crime, corruption, political scandals and fraud are costing Rocklanders hundreds of thousands in taxpayer dollars. The payoffs of housing code reviewers, the use of Medicaid cards to buy food at Costco, the under-the-table payments to women who work in families in cash while also collecting Medicaid and foodstamps is an open secret in Rockland. Costco checkout people laugh about it amongst themselves.

Weighing in on this subject does nothing but give credence to those who are wholly ambivalent to the concerns of the greater Rockland County Community. That video may seem inappropriate and was both poorly contemplated, lacking in decorum and wholly fear-mongering; but it stems for somewhere. It should not be written-off as a deplorable political tactic. It should be understood for a deeper concern amongst Rocklanders. It comes from a very real concern, albeit largely unspoken. To write-it-off without considering the factual truths is to forsake those not depicted in that video and not responsible for its writing and dissemination, the voice of the “others” who have legitimate concerns, whether they funded AG James’ campaign or not. 

College Scandal Tied to Massive Medicare Fraud Case and the Key Worldwide Foundation – Esformes and Singer

William “Rick” Singer

FBI found clues to college admissions scandal years earlier in massive Medicare fraud case

Federal authorities were combing through the finances and phone records of a Miami businessman suspected of Medicare fraud when they came across a curious name: Rick Singer.

Philip Esformes, who was accused of farming out patients from his nursing homes to steal millions in bogus insurance claims, had sent hundreds of thousands of dollars to a foundation Singer controlled. And in text messages discovered on Esformes’ phone, the men discussed how one of Esformes’ sons had performed on his college entrance exams.

Only years later would authorities learn what Esformes had paid Singer to do: Slip his daughter into USC as a fake soccer player and fix his youngest son’s college entrance exam, according to statements a prosecutor made in court and sources familiar with the case.

Singer has said he struck similar deals with dozens more parents, an admission that has roiled higher education and implicated elites from Hollywood, Silicon Valley and the Newport coast.

But in 2016, when agents seized the iPhone Esformes used to text Singer and obtained their messages, Singer was a peripheral, if curious, player in an enormous healthcare fraud investigation. The Esformes case marks the first time Singer is known to have crossed the radar of law enforcement.

Singer would run his admissions scam undisturbed until another team of investigators, working in Boston on an altogether different case, caught a second glimpse of his operation in 2018 and unraveled it.

Andrew Lelling, the U.S. Attorney in Massachusetts, unveiled that investigation in March. Fifty people were charged, including dozens of parents and coaches at such elite schools as Yale, Stanford, Georgetown and USC, who were accused of selling spots that their schools reserved for recruited athletes.

Esformes has not been charged in the college admissions case. Convicted in April of paying and receiving kickbacks in connection with a federal healthcare program and other crimes, he faces decades in prison when a judge sentences him in September. His attorneys declined to comment.

Spokespeople for federal prosecutors in Boston and Miami declined to comment.

It is unclear how much federal authorities uncovered of Esformes’ dealings with Singer while investigating his case. But at his trial in March, a fraud expert used by the government to make sense of his finances testified that Esformes had made $400,000 in payments over several years to Singer’s foundation. At least some of the money was traced to Medicaid and Medicare funds, the expert testified.

Singer has since admitted that his Key Worldwide Foundation was little more than a sham used to launder money from clients and parcel out bribes to coaches, test proctors and bagmen.

Esformes check to The Key.jpg

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Esformes Must Forfeit Interests in Long-Term Care Companies, if Only Others Would Follow

Esformes must forfeit interest in long-term care operating companies, judge rules

Philip Esformes, the Florida assisted living and skilled nursing facility owner found guilty in April of more than 20 charges in a case that the federal government described as “the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice,” must forfeit his interest in seven operating companies related to his facilities, a federal court has ruled.

The decision, issued July 1 in the U.S. District Court for the Southern District of Florida, was a denial of Esformes’ motion asking the court to acquit a jury’s verdict that the assets were forfeitable. The judge’s order applies to Esformes’ interest in the operating companies for the following assisted living or skilled nursing properties: Eden Gardens in Miami, Fair Havens Center in Miami Springs, Flamingo Park Manor in Hialeah, Harmony Health Center in Kendall, North Dade Nursing and Rehabilitation Center in North Miami, Nursing Center at Mercy in Miami and the now-closed Oceanside Extended Care Center in Miami Beach.

“Esformes’s operating companies gave his business a facade of legitimacy as he used them to hold bank accounts and operate the various SNFs and ALFs engaged in the elaborate money laundering and kickback scheme,” U.S. District Judge Robert N. Scola Hr, wrote. “Accordingly, the Court finds that there is sufficient evidence to ‘permit a reasonable jury to conclude that the Government has proven, by a preponderance of the evidence, that the property is subject to forfeiture.’ ”

Scola also denied Esformes’ motions seeking acquittal and a new trial.

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The Abuse and Neglect of the Elderly in Nursing Facilities – Failure to Report and Failure of Oversight

Health Workers Still Aren’t Alerting Police About Likely Elder Abuse, Reports Find

Posted  by Ina Jaffe

NPR [Excertps reprinted from the original to see the original click here.]

Two reports from the federal government have determined that many cases of abuse or neglect of elderly patients that are severe enough to require medical attention are not being reported to enforcement agencies by nursing homes or health workers — even though such reporting is required by law.

Mary Smyth Getty Images

Two reports from the federal government have determined that many cases of abuse or neglect of elderly patients that are severe enough to require medical attention are not being reported to enforcement agencies by nursing homes or health workers — even though such reporting is required by law.

 

It can be hard to quantify the problem of elder abuse. Experts believe that many cases go unreported. And Wednesday morning, their belief was confirmed by two new government studies.

The research, conducted and published by the Office of Inspector General of the U.S. Department of Health and Human Services, finds that in many cases of abuse or neglect severe enough to require medical attention, the incidents have not been reported to enforcement agencies, though that’s required by law.

One of the studies focuses solely on the possible abuse of nursing home residents who end up in emergency rooms. The report looks at claims sent to Medicare in 2016for treatment of head injuries, body bruises, bed sores and other diagnoses that might indicate physical abuse, sexual abuse or severe neglect.

Gloria Jarmon, deputy inspector general for audit services, says her team found that nursing homes failed to report nearly 1 in 5 of these potential cases to the state inspection agencies charged with investigating them.

“Some of the cases we saw, a person is treated in an emergency room [and] they’re sent back to the same facility where they were potentially abused and neglected,” Jarmon says.

But the failure to record and follow up onpossible cases of elder abuse is not just the fault of the nursing homes. Jarmon says that in five states where nursing home inspectors did investigate and substantiate cases of abuse, “97% of those had not been reported to local law enforcement as required.”

State inspectors of nursinghomes who participated in the study appeared to be confused about when they were required to refer cases to law enforcement, Jarmon notes. One state agency said that it contacted the police only for what it called “the most seriousabuse cases.”

Elder abuse occurs in many settings — not just nursing homes. The second study looked at Medicare claims for the treatment of potential abuse or neglect of older adults, regardless of where it took place. The data were collected on incidents occurring between January of 2015 and June of 2017.

The federal auditors projected that, of more than 30,000 potential cases, health care providers failed to report nearly a third of the incidents to law enforcement or Adult Protective Services, even though the law requires them to make such reports.

“It’s very important that the first person who notices this potential abuse and neglect reports it, because then they can begin the investigative process to determine if abuse or neglect occurred,” says Jarmon. “And if it’s not reported, it can’t be tracked.”

The HHSreport says that Medicare could do a better job of analyzing the data it has on hand. It recommends that the Centers for Medicare and Medicaid Services, which oversees the health care program for older Americans, should periodically examine claims for treatment, looking for diagnoses that suggest possible abuse or neglect, as well as where and when those cases occur.

“You have to be able to get the data to see how bad the problem is,” says Jarmon, “so that “everybody who can take action has it.”

However, the Centers for Medicare and Medicaid Services, which pays for much of the health care for seniors and provides guidance on the reporting required ofhealth care workers and health care facilities, has rejected most of the reports’ recommendations.

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The Abject Failure of Nursing Homes in US to Report Thousands of Elder Abuse and Neglect Cases – and a Lack of Oversight

U.S. nursing homes failed to report thousands of elder abuse and neglect cases, report

WASHINGTON — Nursing facilities have failed to report thousands of serious cases of potential neglect and abuse of seniors on Medicare even though it’s a federal requirement for them to do so, according to a watchdog report released Wednesday that calls for a new focus on protecting frail patients.

Just 2 of 69 cases checked in five states were reported to local law enforcement

Auditors with the Health and Human Services inspector general’s office drilled down on episodes serious enough that the patient was taken straight from a nursing facility to a hospital emergency room. Scouring Medicare billing records, they estimated that in 2016 about 6,600 cases reflected potential neglect or abuse that was not reported as required. Nearly 6,200 patients were affected.

“Mandatory reporting is not always happening, and beneficiaries deserve to be better protected,” said Gloria Jarmon, head of the inspector general’s audit division.

Overall, unreported cases worked out to 18% of about 37,600 episodes in which a Medicare beneficiary was taken to the emergency room from a nursing facility in circumstances that raised red flags.

Responding to the report, Administrator Seema Verma said the Centers for Medicare and Medicaid Services does not tolerate abuse and mistreatment and slaps significant fines on nursing homes that fail to report cases.

Verma said the agency, known as CMS, is already moving to improve supervision of nursing homes in critical areas such as abuse and neglect and care for patients with dementia.

CMS officially agreed with the inspector general’s recommendations to ramp up oversight by providing clearer guidance to nursing facilities about what kinds of episodes must be reported, improving training for facility staff, requiring state nursing home inspectors to record and track all potential cases and monitoring cases referred to law enforcement agencies.

Neglect and abuse of elderly patients can be difficult to uncover. Investigators say many cases are not reported because vulnerable older people may be afraid to tell even friends and relatives much less the authorities. In some cases, neglect and abuse can be masked by medical conditions.

The report cited the example of a 65-year-old woman who arrived at the emergency room in critical condition. She was struggling to breathe, suffering from kidney failure and in a state of delirium. The patient turned out to have opioid poisoning, due to an error at the nursing facility. The report said a nurse made a mistake copying doctor’s orders, and the patient was getting much bigger doses of pain medication as a result. The woman was treated and sent back to the same nursing facility. The nurse got remedial training, but the facility did not report what happened. The report called it an example of neglect that should have been reported.

The nursing facilities covered by the report provide skilled nursing and therapy services to Medicare patients recovering from surgeries or hospitalization. Many facilities also play a dual role, combining a rehabilitation wing with long-term care nursing home beds.

Investigators said they faced a challenge scoping out the extent of unreported cases. They couldn’t query a database and get a number, since they were looking for cases that weren’t being reported to state nursing home inspectors.

To get their estimate, auditors put together a list of Medicare billing codes that previous investigations had linked to potential neglect and abuse. Common problems were not on the list. Instead it included red flags such as fractures, head injuries, foreign objects swallowed by patients, gangrene and shock.

The investigators found a total of 37,600 records representing 34,800 patients. Auditors then pulled a sample of cases and asked state inspectors to tell them which ones should have been reported. Based on the expert judgment of state inspectors, federal auditors came up with their estimate of 6,600 unreported cases of potential neglect and abuse.

Investigators found that nursing facility staff and even state inspectors had an unclear and inconsistent understanding of reporting requirements.

Medicare did not challenge the estimates but instead said that billing data comes with a built-in time lag and may not be useful for spotting problems in real time.

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