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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Esformes Convicted – New York’s Versions of Esformes Need to be Prosecuted – Tish James Are you In?

Money, gavel

‘Parasite’ Esformes convicted in $1.3B nursing home fraud, could face remaining years in prison

Florida long-term care business mogul Philip Esformes faces the possibility of decades in prison after being convicted Friday in the largest healthcare fraud scheme ever charged by the U.S. Justice Department.

A 12-person jury deliberated for four days last week before agreeing that the 50-year-old entrepreneur was guilty on 20 out of 26 charges. Those include paying and receiving kickbacks, money laundering and conspiracy to commit federal program bribery. Jurors did not, however, reach a verdict on the main count — that Esformes conspired to defraud Medicare.

Prosecutors blasted Esformes following the conclusion of the eight-week trial for the $1.3 billion scheme to defraud both Medicare and Medicaid, calling him a “despicable,” “vampire” who was fueled by “unbounded greed.”

“Even beyond the vital dollars lost … Esformes exploited and victimized patients by providing inadequate medical care and poor conditions in his nursing homes,” Shimon Richmond, special agent in charge of the U.S. Department of Health and Human Services Office of Inspector General’s Miami Regional Office, said in a statement. “We will continue the fight against such parasites.”

Sentencing has not been scheduled yet, but according to past reports, if convicted, Esformes could stand to face decades in prison.

He was first arrested in July 2016 and has been held without bond since. He could spend the rest of his life in prison, even without a healthcare fraud conspiracy, the Miami Herald said Friday.

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Philip Esformes, Claims that Patients Sold Like Cattle, but… Esformes is Not Alone in Nursing and Healthcare Facilities and the Fraud they Commit

Allowing Owners with Poor Records to Take Over Nursing Home Facilities, a Pattern that Must Stop!

Karen Caffiero, left, and her son, Andrew Burg,  talk in his room at Absolut Center for Nursing and Rehabilitation at Aurora Park in East Aurora on May 9. The nursing home is one of 16 in Erie and Niagara counties that were bought by downstate investors since 2007. (Robert Kirkham/Buffalo News)

Karen Caffiero, left, and her son, Andrew Burg, talk in his room at Absolut Center for Nursing and Rehabilitation at Aurora Park in East Aurora on May 9. The nursing home is one of 16 in Erie and Niagara counties that were bought by downstate investors since 2007. (Robert Kirkham/Buffalo News)

N.Y. fails to weed out nursing home owners with records of poor care

New York State gave licenses to operate at least 10 Buffalo area nursing homes in the last decade to new owners who had been fined for providing poor care to residents at other nursing homes.

Advocates for nursing home residents say the state must do more to prevent nursing home owners providing low-quality care from buying more long-term care facilities.

“It is a real problem with people getting ownership of facilities when they have a poor record of care in other nursing facilities,” said Toby Edelman, a senior attorney at the Center for Medicare Advocacy. “To me the biggest predictor of how a person will do is, how that person did in other facilities the person already owns?”

“New York State falls into this disturbing but all-too-familiar pattern — allowing owners with poor records to take over more facilities,” she said.

Sixteen of the 47 nursing homes in Erie and Niagara counties have been bought since 2007 by for-profit, out-of-town owners. Many of those homes are among the region’s worst rated.

The state allowed some of the out-of-town investors to buy more nursing homes, despite poor ratings and state and federal fines totaling at least $325,000 at ones they already operated.

For instance, in February the state allowed three new New York City area investors to become principals in the corporation that owns Comprehensive Rehabilitation and Nursing Center at Williamsville. The state knew when it approved the change that the new investors owned other nursing homes that had been fined $86,884 in the prior two years for providing poor care. It also knew the federal government was considering an additional $173,110 penalty against one of the homes for failing to protect a disabled resident from abuse.

Yet the state Health Department concluded that it had received “no negative information” about the character and competence of the new co-owners.

The Health Department, which reviews applications to operate nursing homes, now more thoroughly evaluates applicants’ track records running other long-term care facilities, a deputy health commissioner said in September.

Applications to buy nursing homes are approved or rejected by the Health Department’s Public Health and Health Planning Council, 25 volunteers appointed by the governor to serve six-year terms. The members generally represent different disciplines in the health care field from both the public and private sectors.

The Health Department staff about a year ago began providing council members with the federal government’s ratings of other nursing homes owned by prospective buyers, said Deputy Health Commissioner Daniel Sheppard.

He said that sends a message to applicants that quality matters.

But a critic of the council, Assemblyman James Skoufis, D-Woodbury, says its volunteers lack the time to thoroughly vet prospective owners and often rubber-stamp recommendations from the council’s staff.

Skoufis, who was recently elected to the State Senate, has suggested doing away with volunteers and professionalizing the council.

To read the article from THE BUFFALO NEWS, click here.




The Elderly of NY and Elsewhere Deserve Better, they are our Most Vulnerable

November 27, 2018 11:57 AM

The lawsuits allege that understaffing at the facilities has led to infections and unsanitary conditions

A New York law firm filed two class-action lawsuits today against two New York City nursing homes affiliated with Sentosa Care, a large for-profit nursing home group. The lawsuits, brought on behalf of a former patient and the surviving brother of another patient, allege that understaffing at the facilities has led to infections, unsanitary conditions and other examples of inadequate care in violation of state and federal law.

The lawsuits name as defendants the Bronx-based Bay Park Center for Nursing and Rehabilitation in the Bronx and Brooklyn-based Seagate Rehabilitation and Nursing Center, all the owners of the facilities and Sentosa Care itself.

“We’ve gotten many, many complaints from residents [of these facilities] about the horrendous conditions people were left in,” said Jeremiah Frei-Pearson, a partner in the law firm Finkelstein, Blankinship, Frei-Pearson and Garber, which represents the patients in both cases. “People were left in urine and waste for way too long. Federal data also corroborated that these homes are horrific and our own investigation corroborated the conditions.”

Sentosa Care, the subject of a 2015 exposé by ProPublica highlighting low quality ratings at many of its facilities, has nevertheless expanded in New York in other states in recent years. Sentosa Care had at least 25 facilities and nearly 5,400 beds statewide as of 2015, according to ProPublica, but it’s unclear how many New York facilities are affiliated with the network now. In January the Grand Healthcare System sought state approval to purchase two Long Island nursing homes affiliated with Sentosa.

Sherard Clark, the main plaintiff in the case against Bay Park, alleged that he had an open wound on his foot while he was a resident at the nursing home earlier this year, and that the wound got infected multiple times because of a lack of attention from staff. He was often left to change his own bandages and even overheard a doctor reprimanding a nurse for not attending to it, Clark charged in the complaint. When he contracted a staph infection, the home didn’t take the necessary measures to treat it or schedule an appointment with a podiatrist, he added. Clark was also left attached to an empty IV multiple times, and on one occasion, when he attempted to remove it himself, he passed out and fell, hurting his head, according to the complaint.

New York law doesn’t mandate specific patient-to-staff ratios in its hospitals and nursing homes. But Frei-Pearson said, in addition to damages, he plans to seek court orders requiring “sufficient” staffing at both homes to maintain quality care. His law firm has had some success seeking such staff improvements in the past. Earlier this year the law firm reached a settlement of a class action suit against a Syracuse nursing home that included a commitment to boost staffing.

Staffing has been a major issue as the union 1199SEIU negotiates new contracts with 65 downstate nursing homes.

“When it comes to staffing, they’re always short every day, and I think staffing is supposed to be a top priority because quality care is our main concern,” Carol Daley, a unit clerk who has worked at Bay Park for 11 years, said in a video recorded at an informational picket outside the facility last month. “Without that, our residents are at risk for having decubitus, [also known as a bed sore], and anything that goes with not having the good care that they deserve.”

Both Bay Park and Seagate have ratings of three out of five stars on the federal Nursing Home Compare site. Both received just one star for staffing—far below average—but nevertheless scored an above-average five stars on clinical quality measures. The state Health Department gives Bay Park four out of five stars. The facility was hit with 23 citations over the last four years, lower than the statewide average of 32. Seagate scored a three out of five overall from the state Health Department, with 27 citations over the last four years.

To continue reading in Crain’s click here.

Skilled Nursing Homes and Healthcare Facilities in the US, a Travesty – If You Have Information, Please Send It Along

August 13, 2018

House committee needs information for investigation of substandard nursing home care

You may remember that in April of this year, the House Energy and Commerce Committee sent a strong letter to CMS stating that a number of reports and tragic events had raised questions about the adequacy of CMS’ oversight of nursing homes. The Committee requested a wide range of documents and information from CMS.  As part of the Committee’s work, staff on the E&C’s Oversight and Investigations Subcommittee are investigating nursing home care.They have contacted Consumer Voice because they want to look into facilities/corporations with particularly poor care and speak with residents who have experienced substandard care and their family members. 
This is a tremendous opportunity to highlight nursing home problems that we all see and hear about every day and that continue year after year.  While we don’t know what will come from this investigation, we want to provide the subcommittee with as much information as we can. To do this, we need your help!
The subcommittee is requesting the following:
1.    Facilities/owners  – going back no more than roughly 5 years
  • Individual facilities with very poor care, particularly facilities with chronically deficient care. Please indicate the location of the facility.
  • Chains/corporations with a reputation for substandard care
  • Individual owners who have a track record and are well-known for operating bad homes

2.    Residents and families

Staff of the Oversight and Investigations Subcommittee would like to talk to residents and/or family members who have experienced poor care (or other issues) within the past 5 years and are willing to share their personal experience. 
Please provide:
  • First and last names
  • Whether they are a resident or a family member
  • Contact information (phone number and/or email).  Note:  You may want to consider limiting this to residents with a phone in their room or a cell phone to better ensure privacy and confidentiality.
  • A very brief description of the problem(s) they experienced (for instance, developed pressure ulcers because there were not enough staff to reposition me as needed).
 Subcommittee members will speak with individuals by phone, although it’s possible that not all individuals will be contacted for an interview depending on the number of responses. All information will remain confidential.
Please help us help the Oversight and Investigations Subcommittee staff investigate poor care by sending any of the requested information by August 20  to Robyn Grant
A very big thank you to everyone for your assistance!
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Recipients of this email include all state long-term care ombudsmen, Consumer Voice members, Action Network members and other individuals who have subscribed to our e-mail list
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In August, the House Energy and Commerce Committee requested information regarding Nursing Homes, in response to a number of tragic events that “raised questions about the adequacy of CMS’ oversight” of nursing homes.

While the deadline has since passed, at least officially, we do not believe that they would ignore reports, were anything to be sent along. The following is the letter which precipitated the committee’s response.

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