Medicare Fraud

Two major players in a billion-dollar nursing home-related fraud case have pled guilty and could face years in prison.

Former hospital leader Odette Barcha admitted in federal court Wednesday to conspiring to defraud the government, and to both paying out and receiving healthcare kickbacks. Barcha was part of a massive fraud scheme, along with Miami Beach businessman Philip Esformes, which involved improper billing and patient placement at more than 30 Miami-area nursing homes and assisted living facilities.

Barcha will face up to five years in prison on that single count, with prosecutors agreeing to drop seven additional charges as part of a plea agreement, Law360 reported Wednesday. A third participant, former physician’s assistant Arnaldo Carmouze, also faces up to 10 years in prison after he pled guilty last week to a single count of conspiracy to commit healthcare fraud. Both face hefty potential fines.

Federal prosecutors first charged the trio in July 2016, alleging they ran a complex scheme to defraud both Medicare and Medicaid. Prosecutors said at the time that it was the largest health fraud case ever brought forward by the Department of Justice.

For her part, Barcha allegedly had physicians discharge patients from Larkin Community Hospital into Esformes-owned eldercare facilities, with the businessman paying kickbacks for those admissions. Payments were sometimes disguised from authorities as charitable donations or charges for escorts.

Carmouze for his part, signed falsified or altered medical documents.  Patients often never received necessary services, authorities said. More than $2.9 million in healthcare program losses are tied to Barcha, and another $16 million to Carmouze.

Esformes is in prison awaiting trial, which is set to start on Feb. 11.