Esformes housed elderly patients alongside younger patients who suffered from mental illness and drug addiction. And between the years 20, he billed approximately a billion dollars to federal health insurance programs for questionable services that, in many cases, patients didn’t even receive. He ran a network of 16 skilled-nursing and assisted living facilities (ALFs) across Chicago and Miami. Philip Esformes made $78 million in 2017. Other categories of healthcare fraud include: billing for a more expensive procedure than the one that was actually performed performing medically unnecessary procedures just to receive insurance payments re-categorizing medically unnecessary procedures as medically necessary and accepting or receiving kickbacks for patient referrals.Īt a time when the expansion of healthcare services sits atop the political agenda of many Americans, fighting healthcare fraud has never been more important.įamous Case: The Philip Esformes Billion-Dollar Fraud If there’s a way to rip off some portion of the healthcare system, healthcare fraudsters have likely already found it and exploited it. But the demons of healthcare fraud are more nefarious than just that. In its simplest form, it’s billing for a service that wasn’t provided or for a more expensive procedure than medically necessary and then collecting payment from an insurance provider (or taxpayer-funded programs like Medicare and Medicaid). Healthcare fraud, which costs the nation billions of dollars every year, consists of filing dishonest healthcare claims in order to earn a profit.

By pocketing money that’s meant to pay for medically necessary procedures, those who commit healthcare fraud effectively steal from the sick-and from taxpayers-in order to make themselves more wealthy. In a hypothetical Dante’s Inferno scenario where all of the world’s white collar criminals were arranged in descending order of wickedness, healthcare fraudsters would sit somewhere between hell’s eighth and ninth concentric rings.

Hhs oig special agent