Morning Briefing
Summaries of health policy coverage from major news organizations
Florida Health Care Businessman Charged In $1B Medicare Fraud Scheme, One Of Biggest In History
The Washington Post: Florida Businessman Convicted In $1B Medicare Fraud Case
A federal jury on Friday convicted a Florida health care executive on 20 criminal counts in what prosecutors described as a $1 billion Medicare fraud scheme. Jurors reached a partial verdict after four days of deliberating the fate of Philip Esformes in one of the biggest such cases in U.S. history. Jurors were undecided on six additional counts, but prosecutors accepted the verdict rather than send them back for further deliberations. (Gomez Licon, 4/5)
Bloomberg: Man Who Bribed Son Into Penn Guilty In $1.3 Billion Health Fraud
Philip Esformes, a 50-year-old Miami Beach resident, used a network of nursing homes and assisted-living facilities in South Florida to defraud U.S. government health-care programs while providing inadequate and unnecessary care to patients, prosecutors said. Esformes made off with at least $37 million for himself from 1998 to 2016, according to prosecutors, using the money to finance a lavish lifestyle of fancy cars and a $360,000 watch. Esformes also used some of the proceeds from the fraud to bribe the University of Pennsylvania basketball coach to help get his son into the school, prosecutors said. (Tozzi, 4/5)
Modern Healthcare: Fla. Healthcare Executive Found Guilty In $1B Medicare Fraud Case
During the seven-week trial in federal court in Miami, prosecutors called Esformes a trickster and mastermind of a scheme paying bribes and kickbacks to doctors to refer patients to his nursing home network from 2009 to 2016. The fraud also included paying off a regulator to learn when inspectors would make surprise visits to his facilities, or if patients had made complaints. Esformes owns dozens of Miami-Dade nursing facilities as well as homes in Miami, Los Angeles and Chicago. (4/5)
Modern Healthcare: Illinois Testing New Program To Reduce Medicare Fraud
Illinois is the first state to participate in a new Centers for Medicare & Medicaid Services program for home health agencies that aims to prevent Medicare fraud, protect patients and minimize the burden on medical providers. The program, called the Review Choice Demonstration for Home Health Services, was created to test whether choosing from three claim review options reduces fraud in the state among organizations that provide skilled nursing services to Medicare beneficiaries, according to CMS. (Goldberg, 4/5)
