I have written four 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.
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 done out of compassion based on medical or family issues. It may also be the result of the recipient having “turned over a new leaf,” and having gone on to provide a service to our society. Unfortunately, none of these appear to apply to Esformes.
Shockingly, Esformes could even petition to get his rights to buy nursing homes and participate in the Medicare program restored. I am doubtful the incoming administration will allow this, but the commutation really sends the wrong message to an industry known for corruption.
Having lived and worked in healthcare for 40 years, and having lived in South Florida for 13 years, I am concerned about the impact of fraud on our ability to pay the cost of healthcare. There are more people like Mr. Esformes out there.
As an example, and I am not naming names, there is a well-known owner of a number of nursing homes in South Florida that would park his Ferrari in the handicapped spot in front of his nursing homes, even when regulators were showing up to audit his books.
My concern, in a larger sense, is that the bribing of physicians to admit patients to long-term care facilities has a long and sad history in South Florida – and this just encourages bad actors to try even harder.
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Last August, the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG) reported its findings on a review of certain MS-DRGs
The distinction between laws and regulations is a fundamental aspect of governance in the United States, particularly in highly regulated sectors such as healthcare. With
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