The defendant convicted in connection of one of the most massive fraud schemes in U.S. healthcare history is free after his sentence was commuted.
I have written five previous articles on Philip Esformes, who was sentenced to 20 years in federal prison for a truly infamous scheme to defraud Medicare out of millions of dollars. He bribed doctors and other providers of care to send patients to his skilled nursing homes.
Esformes, the operator of a total of 16 skilled nursing and assisted living facilities in South Florida, was found guilty on 20 charges, including paying bribes and kickbacks to bring Medicare patients into his businesses. According to Assistant Attorney General Brian A. Benczkowski of the U.S. Justice Department’s Criminal Division, “Philip Esformes orchestrated one of the largest healthcare fraud schemes in U.S. history, defrauding Medicare and Medicaid to the tune of over a billion dollars.”
At his sentencing, Judge Robert Scola said Esformes’s illegal plotting to get Medicare patients was “unmatched in our community, if not our country.” The judge went on to say that Esformes “violated trust in epic proportions.”
Normally, a commutation of a federal prison term is granted out of compassion based on medical or family issues. It may also be the result of the recipient having “turned over a new leaf,” having gone on to provide a service to our society. Unfortunately, none of these appear to apply to Esformes, whose sentence was commuted by former President Donald Trump shortly before Christmas last year, after he had served fewer than five years of his 20-year term.
Yet the federal government is now trying Esformes on charges not related to the ones commuted. Concerned that a convicted healthcare mogul freed in such fashion might flee the country, Justice Department prosecutors urged a federal judge Tuesday to confine Esformes to his South Florida home with an electronic ankle monitor, and impose a $10.5 million bond to ensure his appearance for a new trial.
But their request was effectively rebuffed, at least for now. Judge Scola instead granted a request by Esformes’s defense team to postpone the government’s bond proposal until mid-August, when it will be taken up again.
Programming Note: Listen to Tim Powell at 10 a.m. EST every Tuesday on Talk Ten Tuesdays, when he anchors the broadcast’s News Desk.
The educational content and schedule for the upcoming Open Door Forum Webcast series produced by RACmonitor and ICD10monitor have been unveiled. The announcement was made
Amid a crowded galaxy of well-known regulatory and process subject-matter experts, five extraordinary respected and renowned healthcare professionals are poised to lead a new series
Please log in to your account to comment on this article.
Stop revenue leakage and boost hospital performance by mastering risk adjustment and HCCs. This essential webcast with expert Cheryl Ericson, RN, MS, CCDS, CDIP, will reveal how inaccurate patient acuity documentation leads to lost reimbursements through penalties from poor quality scores. Learn the critical differences between HCCs and traditional CCs/MCCs, adapt your CDI workflows, and ensure accurate payments in Medicare Advantage and value-based care models. Perfect for HIM leaders, coders, and CDI professionals. Don’t miss this chance to protect your hospital’s revenue and reputation!
Struggling with ICD-10-CM coding for diabetes and complications? This expert-led webcast clarifies complex combination codes, documentation gaps, and sequencing rules to reduce denials and ensure compliance. Dr. Angela Comfort will provide actionable strategies to accurately link diabetes to complications, improve provider documentation, and optimize reimbursement—helping coders, CDI specialists, and HIM leaders minimize audit risks and strengthen revenue integrity. Don’t miss this chance to master diabetes coding with real-world case studies, key takeaways, and live Q&A!
Uncover critical guidance. HIM coding expert, Kay Piper, RHIA, CDIP, CCS, provides an interactive review on important information in each of the AHA’s 2025 ICD-10-CM/PCS Quarterly Coding Clinics in easy-to-access on-demand webcasts, available shortly after each official publication.
Uncover critical guidance. Kay Piper provides an interactive review on coding guidelines and more in the AHA’s fourth quarter 2025 ICD-10-CM/PCS Coding Clinic in an easy to access on-demand webcast.
RACmonitor is proud to welcome back Dr. Ronald Hirsch, one of his most requested webcasts. In this highly anticipated session, Dr. Hirsch will break down the complex Two Midnight Rule Medicare regulations, translating them into clear, actionable guidance. He’ll walk you through the basics of the rule, offer expert interpretation, and apply the rule to real-world clinical scenarios—so you leave with greater clarity, confidence, and the tools to ensure compliance.
Bring your questions and join the conversation during this open forum series, live every Wednesday at 10 a.m. EST from June 11–July 30. Hosted by Chuck Buck, these fast-paced 30-minute sessions connect you directly with top healthcare experts tackling today’s most urgent compliance and policy issues.
Fraud convictions don’t just punish a few bad claims; they can wipe out years of reimbursements. Don’t wait for an audit to learn the rules. Join Frank Cohen, MPA, for a live Q&A on spotting red flags, avoiding liability, and protecting your practice. Register now and bring your questions!
Substance abuse is everywhere. It’s a complicated diagnosis with wide-ranging implications well beyond acute care. The face of addiction continues to change so it’s important to remember not just the addict but the spectrum of extended victims and the other social determinants and legal ramifications. Join John K. Hall, MD, JD, MBA, FCLM, FRCPC, for a critical Q&A on navigating substance abuse in 2025. Register today and be a part of the conversation!
Copyright © 2025 ICD10monitor. Powered by MedLearn Media.
Prepare for the 2025 CMS IPPS Final Rule with ICD10monitor’s IPPSPalooza! Click HERE to learn more
Get 15% OFF on all educational webcasts at ICD10monitor with code JULYFOURTH24 until July 4, 2024—start learning today!
CYBER WEEK IS HERE! Don’t miss your chance to get 20% off now until Dec. 2 with code CYBER24
