Three People Charged: Billion-Dollar Fraud in Nursing Homes

Three people have been charged with an unprecedented billion-dollar health insurance fraud, using dozens of nursing homes in Miami, according to an indictment released today, reports the Patria news agency. 

"This is the largest single criminal health care fraud ever," said Leslie Caldwell, Assistant Attorney General of the Criminal Division of the Department of Justice.

Authorities say that Philip Esformes, who ran 30 nursing homes, along with two accomplices and a complex network of corrupt doctors and hospitals, transferred thousands of beneficiaries to his facilities, even though they were not entitled to such services, some of which were harmful to them.

Thus, among the residents were drug addicts who were prescribed opioids to entice them to stay in those homes where they otherwise should not have been, Caldwell said at a press conference.

In 2006, Esformes paid $15.4 million to settle a civil lawsuit over a similar fraud involving federal health care protections, but continued his activity through a developed money laundering system.

Miami has long been a hub of health insurance fraud, with complex schemes ranging from medical equipment and infusions to home health care fraud, U.S. media report.