Largest Single Healthcare Fraud Case in U.S. History

The U.S. Justice Department just recently indicted three Florida residents in the “largest single criminal healthcare fraud case ever brought against individuals.” While the case has not gone to trial yet, the numbers are staggering. It is alleged that over $1 billion in Medicare and Medicaid billings were fraudulently charged by just a few co-conspirators – one of whom owned several skilled nursing and assisted living facilities and two who worked for a local hospital.

It is disheartening to see the purposeful overutilization and advantage taken of the elderly, poor, and mentally disabled in the story. I was especially saddened to read that patients were purposely addicted to drugs so they could continue the billing cycle scam.

“Defendant [Esformes] and his co-conspirators preyed upon his beneficiaries addictions by providing them with narcotics so that the beneficiaries would remain in Esformes Network facilities, allowing the cycle of fraud [to] continue,” prosecutors said in a court filing.

This is a hard reminder that there are unfortunately a number of “bad players” in healthcare and our industry needs to stay vigilant to prevent the fraud and abuse that can arise out of the system.