Philip Esformes, the disgraced nursing home and assisted living community owner charged in a record $1.3 billion healthcare fraud case in 2016, has reached a plea deal with prosecutors on outstanding charges against him.
At the time of his apprehension, the federal government called Esformes’ vast web of deceit “the largest healthcare fraud scheme [ever] charged by the US Justice Department.”
Senior Judge Robert N. Scola Jr. of the US District Court for the Southern District of Florida on Thursday announced the cancellation of a conference call to discuss the status of the case, which had been scheduled for Friday, “in light of the parties representation that they have reached a plea.”
A change of plea and sentencing hearing would be scheduled, Scola said. CNBC reports that the hearing has been scheduled for Feb. 22.
According to the Miami Herald, under the terms of the deal, Esformes will plead guilty to a count of conspiracy, and five other charges will be dismissed. Esformes also reportedly will be required to pay $5.5 million in restitution to the Centers for Medicare & Medicare Services and pledge at least $14 million in assets toward his outstanding forfeiture penalty of $38.7 million, the amount of money he received from the Medicare program through fraudulent billing between 2010 and 2016.
Esformes was convicted in 2019 on charges including conspiracy to defraud the United States, money laundering, paying and receiving kickbacks, bribery, wire fraud and obstruction of justice. The jury, however, did not reach a verdict on six counts, which prosecutors said they intended to pursue.
Federal prosecutors were free to retry Esformes on the six counts after the US Supreme Court in December declined to hear an appeal.
It marked the second time in 2023 that the high court denied an appeal from Esformes. In April, Justice Clarence Thomas rejected an emergency appeal seeking to stay a decision from the 11th US Circuit Court of Appeals affirming his 2019 conviction on 20 charges. Esformes’ attorneys had argued that the case should be thrown out after the government improperly seized and used documents protected by attorney-client privilege.
Former President Donald Trump comminuted Esformes’ 20-year prison sentence in December 2020 but left intact the remaining parts of his sentence, including three years of supervised release, the payment of restitution and the forfeiture of property equivalent to the value traced back to Esformes’ money laundering offenses.
Reality TV personality Kim Kardashian shined the spotlight on Esformes’ case last spring in a series of tweets a few days after federal prosecutors received the green light to retry Esformes on pending healthcare fraud charges.
In November, the Miami Herald reported that a plea deal appeared to be in the works. In January, Bloomberg Law reported that Guy Lewis, a former US attorney for the Southern District of Florida, said that it was “almost certain” that a retrial would set a precedent “that any pardon or commutation by a president might not be the final say.”
Esformes was first charged in 2016. The federal government, in part, alleged that he would move skilled nursing residents to his assisted living facilities when they were at or near the end of Medicare’s 100-day post-hospital benefit period for skilled nursing. “After the required 60-day waiting period between consecutive admissions to an [sic] SNF, a physician or physician assistant would readmit the beneficiary to the hospital, re-initiating the cycle,” according to a federal motion in 2016.
Meanwhile, the government alleged, Esformes provided access to assisted living residents “for any healthcare provider willing to pay a kickback” — including pharmacies, home health agencies, physician groups, therapy companies, partial hospitalization programs, laboratories and diagnostic companies — even though many of the services for which they were paid were not medically necessary or were never provided.
