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Trump commutes Philip Esformes’ prison sentence

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Trump pardoned the Miami fraudster behind a $1.3B Medicare and Medicaid fraud scheme.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Clipped from: https://www.chicagotribune.com/news/criminal-justice/ct-philip-esformes-fraud-trump-clemency-commutation-20201223-tfn7rveawzdhjmhee6hx7eoccm-story.html

 
 

In this Aug. 7, 2015, file photo, Philip Esformes arrives at the 15th Annual Harold and Carole Pump Foundation Gala held at the Hyatt Regency Century Plaza, in Los Angeles. (Rob Latour/Invision/AP)

Chicago-area nursing home mogul Philip Esformes was once called the “king” of Medicaid fraud, accused of cycling elderly, destitute and drug-addicted patients through his network of facilities and billing millions of dollars to government programs, often for services never rendered, according to federal prosecutors.

In sentencing Esformes to 20 years in prison last year, a federal judge in Miami called the length and scope of his criminal conduct “unmatched in our community, if not the country” and an “epic” violation of trust.

Now, Esformes, 52, is a free man, released from a Florida prison on Tuesday after President Donald Trump commuted his sentence, granting clemency to 20 people in all. The group included former Republican members of Congress; military contractors convicted of killing civilians in Iraq; and Chicagoan George Papadopoulos, a campaign aide who pleaded guilty to making false statements in the investigation into Russian interference in the 2016 election.

Esformes was arrested in 2016 at his Miami estate and charged with a massive $1.3 billion Medicare and Medicaid fraud scheme that at the time was billed by the U.S. Justice Department as the largest single criminal health care fraud case ever brought.

In announcing the president’s decision, the White House said the clemency was supported by former Attorneys General Edwin Meese and Michael Mukasey, as well as former Deputy Attorney General Larry Thompson.

A statement by press secretary Kayleigh McEnany alluded to Esformes’ pending appeal of his conviction, which alleged massive overreach by overzealous prosecutors who used illegally gathered evidence at trial that violated the attorney-client privilege. The statement also noted that Esformes “has been devoted to prayer and repentance” while in prison and is in declining health.

His attorney, Howard Srebnick, did not comment directly on the president’s order, but said in a statement that the comments from the White House demonstrate “that the president was deeply disturbed by the prosecutors’ invasion of the attorney-client privilege.”

The Chicago Tribune began chronicling Esformes’ rise to nursing home mogul more than a decade ago, when he, along with his father and business partner controlled a network of more than two dozen health care facilities that stretched from Chicago to Miami.

At one point, the flashy, Ferrari-driving Esformes owned millions of dollars in real estate, crisscrossing the country on private jets to spend time at his luxury condominium on Chicago’s Magnificent Mile and mansions in Miami and Los Angeles.

But allegations of fraud and neglect piled up in Chicago and Miami. A 2010 whistleblower lawsuit alleged that the giant pharmaceutical firm Omnicare Inc. paid millions in kickbacks to secure long-term contracts with Esformes’ facilities, the Tribune reported.

The Tribune also found that families had filed 20 wrongful death lawsuits over a four-year period against seven of Esformes’ facilities in Miami-Dade County, including one case where a patient was allegedly attacked by a fellow resident, then sent to another Esformes-owned facility, where he suffered a catastrophic fall and died of a brain injury.

His indictment alleged Esformes and a handful of Miami co-conspirators bilked the federal programs for 14 years by cycling some 14,000 patients through various facilities, where many received unnecessary or even harmful treatments. Drug addicts were allegedly lured to the facilities with promises of narcotics, and prosecutors say some received OxyContin and fentanyl without a physician’s order to entice them to stay.

He housed elderly patients alongside younger adults who suffered from mental illness and drug addiction — sometimes with fatal results, prosecutors alleged. In Esformes’ Oceanside Extended Care Center in Miami Beach, “an elderly patient was attacked and beaten to death by a younger mental health patient who never should have been at (a nursing facility) in the first place,” prosecutors wrote in a pre-sentencing memorandum.

As part of the kickbacks exchanged between Esformes and corrupt medical professionals, “high-end escorts” were flown to Orlando and chauffeured in limousines for liaisons with Esformes at the Ritz-Carlton Hotel, according to prosecutors.

Esformes, meanwhile, drove a $1.6 million Ferrari Aperta and published a blog with fitness tips for busy executives, prosecutors said. He even used some $300,000 in stolen proceeds to bribe the head men’s basketball coach at the University of Pennsylvania to admit Esformes’ son to the school, according to one count of the indictment.

That coach, Jerome Allen, pleaded guilty to money laundering and testified against Esformes at the Miami trial.

A jury convicted Esformes of paying bribes, money laundering, and other crimes, but was unable to reach a verdict on the main count of conspiring to defraud the Medicare program for the elderly and indigent. His appeal is pending before the 11th Circuit U.S. Court of Appeals in Florida, records show.

At his sentencing hearing in January 2019, Esformes wept and pleaded for mercy, saying “there is no one to blame but myself.” While preparing his defense, Esformes told the judge, he had listened repeatedly to wiretapped conversations that revealed him arranging bribes and was “disgusted” by what he heard.

“The Phil Esformes you heard was reckless … an arrogant man,” he said, crying as he pounded the lectern with his fist.

Prosecutors had requested 30 years behind bars. But U.S. District Judge Robert Scola Jr. said he was taking into account Esformes’ history of helping people in need.

Attorneys for Esformes had described him as a selfless philanthropist who had donated more than $15 million to synagogues, schools and needy individuals, often anonymously.

jmeisner@chicagotribune.com

 
 

 
 

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North Dakota AG charges service provider with Medicaid fraud

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Rebecca Fruge fraudulently billed $76,000 for in home medical services for times her client was in the hospital, and for 3 different 24 hour days.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

BISMARCK, N.D. (AP) — The North Dakota attorney general’s office is charging a Mandan woman with Medicaid fraud for allegedly submitting $76,000 worth of claims for work she did not perform.

The Bismark Tribune reports the Department of Human Services began looking into claims Rebecca Fruge made for in-home medical services after she claimed she had performed more than 24 hours of work on three separate days in May last year.

The department also found that Fruge’s client was in the hospital for one of those days and could not have received services from her. Fruge has denied submitting incorrect or fraudulent claims, investigators say.

 
 

 
 

Clipped from: https://www.kxnet.com/news/local-news/north-dakota-ag-charges-service-provider-with-medicaid-fraud/

 
 

 
 

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Kentucky dentist who pulled good teeth sentenced to prison

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A Kentucky dentist plead guilty to stealing $70,000 from Medicaid in an upcoding scheme.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Crime


By Bill Estep

December 17, 2020 09:27 AM

An Eastern Kentucky dentist who admitted getting higher payments from Medicaid through inflated bills has been sentenced to four months in prison.

Denver “Dickie” Tackett also must serve six months of home detention after his prison sentence, repay $70,012 to Medicaid and pay the government $20,000.

U.S. District Judge Gregory F. Van Tatenhove sentenced Tackett on Tuesday.

Tackett, who practiced for more than 30 years at McDowell, in Floyd County, pleaded guilty in August to a charge of health care fraud.

Tackett acknowledged that he submitted claims for treating patients that were not reasonable and necessary between 2003 and 2018.

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One example was that he filed claims to be paid for performing more complex surgical tooth extractions when he had only done simple extractions, which were reimbursed at a lower rate, according to the plea agreement.

Tackett billed Medicaid for some medically unnecessary procedures; submitted claims for providing emergency care without sufficient justification; and filed claims to get paid for procedures related to an earlier unnecessary extraction, the plea agreement said.

Tackett acknowledged pulling people’s teeth when it wasn’t necessary, but his attorney, Andrew L. Sparks, said patients asked Tackett to do that.

It was not uncommon for people to ask to have their teeth pulled while the service was covered by Medicaid out of concern that they would lose coverage later, Sparks said in a sentencing memorandum.

The indictment in the case also charged Tackett with 15 counts of improperly distributing opioid pain pills, but those charges were dropped as part of the plea.

Sparks sought probation for Tackett, noting letters of support that described Tackett as a caring, dedicated dentist who worked long hours to help people, treated patients even if they couldn’t pay and sometimes paid for a patient’s prescription.

One woman described how her son damaged a front tooth playing basketball and Tackett opened his office at 7 p.m. on Christmas Eve to treat him, saving the tooth.

Tackett, who is an ordained minister through the United Methodist Church and the Assembly of God Pentecostal Church, was not motivated by a desire for wealth, according to the sentencing memo.

“Dr. Tackett’s history and characteristics show a man dedicated to his faith, his family and his patients,” the memo said. “These letters make clear that Denver Tackett is a good and decent man.”

Sparks argued Tackett had been punished enough by losing his practice.

Prosecutors argued for a sentence of 18 to 24 months, saying the health care system depends on providers being trustworthy and assumes that they will only bill for necessary services they actually perform.

A review by a consultant at the University of Kentucky showed a pattern by Tackett of prolonging treatment and performing procedures patients didn’t need, resulting in payments to him, prosecutors said.

Prosecutors also argued that prescriptions Tackett wrote for opioid painkillers played a role in the drug problem.

“Several of these patients told investigators that they became addicts as a result of Dr. Tackett’s prescriptions or that Dr. Tackett contributed to their addictions by continuing to prescribe controlled substances to them,” prosecutors wrote.

Tackett was among 60 health providers in seven states charged in April 2019 as part of an investigation of alleged improper prescribing.

Some other providers charged in Kentucky in the roundup have also been convicted.

Clipped from: https://www.kentucky.com/news/local/crime/article247913615.html

 
 

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Office Manager of doctor indicted for $23M in healthcare fraud pleads guilty

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A surgeon and his office manager billed Medicare and Medicaid for more than 3,000 surgeries that never happened. In the process they stole $23M.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

Kimberly Austin changed her plea in a hearing on the afternoon of Nov. 13.(WCTV)

TALLAHASSEE, Fla. (WCTV) – The office manager of Dr. Moses deGraft-Johnson plead guilty to one count of conspiracy to commit healthcare fraud on Friday. Kimberly Austin changed her plea in a hearing on the afternoon of Nov. 13.

Austin and deGraft-Johnson were indicted in February; the 58 count indictment alleges that they defrauded Medicare and Medicaid, billing for surgeries that were never performed. Prosecutors say the improper billing hit $23 million; they said in 3,600 surgeries billed over five years, 85 to 90% never happened.

Prosecutors also say the surgery deGraft-Johnson claimed to perform is “relatively rare,” and that he did not have enough of the devices required to do the surgeries.

The two worked at the Heart and Vascular Institute of North Florida.

The change of plea hearing for Austin lasted about 45 minutes, with the Judge checking that her guilty plea was not coerced and ensuring it is “voluntary and factual.”

Austin faces up to 10 years in prison for the conspiracy charge.

During her testimony, she said she was born, raised, and has always lived in Sneads, Florida.

She was visibly shaken during the testimony in front of Judge Mark Walker.

“It’s readily apparent to me that you’re upset, that you’re remorseful,” said Judge Walker. “I can tell this is a big deal to you.”

The Judge went over three documents during the hearing: a plea agreement, a supplemental plea agreement, and a statement of facts. He explained that it is up to the prosecutors to file a substantial assistance motion, depending on her testimony.

The statement of facts was 59 pages; Judge Walker cross-checked certain aspects with Austin.

“He used your assistance to pull of his scheme, correct?” he asked.

“Yes, sir,” said Austin.

“You admit you helped him commit healthcare fraud?”

“Yes, sir,” said Austin.

Austin testified that she covered for the doctor when patients called and complained, and said she knew he was billing for procedures that took place when he was out of the office.

She is out of custody under the conditions previously set by the magistrate judge. Austin’s sentencing is set for 2:30 p.m. on March 18; deGraft-Johnson’s trial is set for Jan. 25.

 
 

 
 

Clipped from: https://www.wctv.tv/2020/12/14/office-manager-of-doctor-indicted-for-23-million-in-healthcare-fraud-pleads-guilty/

 
 

 
 

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Kentucky dentist who pulled good teeth sentenced to prison | Lexington Herald Leader

MM Curator summary:

 
 

A Kentucky dentist plead guilty to stealing $70,000 from Medicaid in an upcoding scheme.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

Crime


By Bill Estep

December 17, 2020 09:27 AM

An Eastern Kentucky dentist who admitted getting higher payments from Medicaid through inflated bills has been sentenced to four months in prison.

Denver “Dickie” Tackett also must serve six months of home detention after his prison sentence, repay $70,012 to Medicaid and pay the government $20,000.

U.S. District Judge Gregory F. Van Tatenhove sentenced Tackett on Tuesday.

Tackett, who practiced for more than 30 years at McDowell, in Floyd County, pleaded guilty in August to a charge of health care fraud.

Tackett acknowledged that he submitted claims for treating patients that were not reasonable and necessary between 2003 and 2018.

News alerts in your inbox

One example was that he filed claims to be paid for performing more complex surgical tooth extractions when he had only done simple extractions, which were reimbursed at a lower rate, according to the plea agreement.

Tackett billed Medicaid for some medically unnecessary procedures; submitted claims for providing emergency care without sufficient justification; and filed claims to get paid for procedures related to an earlier unnecessary extraction, the plea agreement said.

Tackett acknowledged pulling people’s teeth when it wasn’t necessary, but his attorney, Andrew L. Sparks, said patients asked Tackett to do that.

It was not uncommon for people to ask to have their teeth pulled while the service was covered by Medicaid out of concern that they would lose coverage later, Sparks said in a sentencing memorandum.

The indictment in the case also charged Tackett with 15 counts of improperly distributing opioid pain pills, but those charges were dropped as part of the plea.

Sparks sought probation for Tackett, noting letters of support that described Tackett as a caring, dedicated dentist who worked long hours to help people, treated patients even if they couldn’t pay and sometimes paid for a patient’s prescription.

One woman described how her son damaged a front tooth playing basketball and Tackett opened his office at 7 p.m. on Christmas Eve to treat him, saving the tooth.

Tackett, who is an ordained minister through the United Methodist Church and the Assembly of God Pentecostal Church, was not motivated by a desire for wealth, according to the sentencing memo.

“Dr. Tackett’s history and characteristics show a man dedicated to his faith, his family and his patients,” the memo said. “These letters make clear that Denver Tackett is a good and decent man.”

Sparks argued Tackett had been punished enough by losing his practice.

Prosecutors argued for a sentence of 18 to 24 months, saying the health care system depends on providers being trustworthy and assumes that they will only bill for necessary services they actually perform.

A review by a consultant at the University of Kentucky showed a pattern by Tackett of prolonging treatment and performing procedures patients didn’t need, resulting in payments to him, prosecutors said.

Prosecutors also argued that prescriptions Tackett wrote for opioid painkillers played a role in the drug problem.

“Several of these patients told investigators that they became addicts as a result of Dr. Tackett’s prescriptions or that Dr. Tackett contributed to their addictions by continuing to prescribe controlled substances to them,” prosecutors wrote.

Tackett was among 60 health providers in seven states charged in April 2019 as part of an investigation of alleged improper prescribing.

Some other providers charged in Kentucky in the roundup have also been convicted.

Clipped from: https://www.kentucky.com/news/local/crime/article247913615.html

 
 

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Two area home health agency owners charged in health care fraud and illegal kickback scheme | Woodlands Online

MM Curator summary:

 
 

Charlz and Angela Bisong of Texas paid Medicare members to sign up for unneccessary services so they could steal $10M from Medicare.

 
 

The article below has been highlighted and summarized by our research team. It is provided here for member convenience as part of our Curator service.

 
 

 
 

HOUSTON, TX — Two home health agency owners are set to appear in federal court on charges they fraudulently billed more than $10 million to Medicare, announced U.S. Attorney Ryan K. Patrick.

Authorities arrested Tataw Charlz Bisong and Angela Bisong, both 57 and from Stafford, today. They are expected to make their initial appearances before U.S. Magistrate Judge Frances H. Stacy at 2 p.m.


A federal grand jury in Houston returned the indictment under seal Dec. 9, which was unsealed today. It alleges the Bisongs co-owned SierCam Healthcare Services LLC. From 2012 through 2020, SierCam allegedly billed Medicare for home health services that were not medically necessary and often not provided as billed to Medicare. The charges allege the Bisongs paid SierCam patients to sign up for medically unnecessary home health services and provided free transportation and covered the copayments and other fees at doctor’s office visits to facilitate their health care fraud scheme. Additionally, the Bisongs created phony medical records to make it appear the services met Medicare’s criteria for reimbursement, according to the indictment.


Charlz and Angela Bisong are both charged with one count of conspiracy to commit health care fraud, six counts of health care fraud and one count of conspiracy to pay and receive health care kickbacks.


Conspiracy to commit health care fraud and each of the six counts of health care fraud carry a maximum sentence of 10 years in federal prison and a maximum $250,000 possible fine, upon conviction. If convicted of conspiracy to pay and receive health care kickbacks, they also face up to five years in federal prison and a possible $25,000 maximum fine.


The FBI, Department of Health and Human Services?Office of Inspector General and Texas Attorney General’s Medicaid Fraud Control Unit conducted the investigation. The Stafford and Sugar Land Police Departments assisted in the arrests. Special Assistant U.S. Attorney Kathryn Olson is prosecuting the case.


An indictment is a formal accusation of criminal conduct, not evidence. A defendant is presumed innocent unless convicted through due process of law.

 
 

 
 

Clipped from: https://www.woodlandsonline.com/npps/story.cfm?nppage=68674

 
 

 
 

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Centene Is Climbing on Its Plans to Buy Magellan Health for $2.2 Billion

MM Summary

Centene adds a giant pharmacy services component with the purchase of Magellan.

M&A activity continues to pick up in the health-care space.

Centene (ticker: CNC) announced Monday that it will pay $95 per share for Magellan Health (MGLN), a 14.7% premium over Magellan’s closing price last Thursday of $82.84. Shares of Magellan were up 12.3%, to $93.00, in early trading on Monday.

Shares of Centene, meanwhile, were up 1% at the open of trading Monday, to $60.62.

The deal comes a year after Centene closed its $17.3 billion acquisition of WellCare Health Plans, another insurer focused on government-sponsored health plans. Centene is one of the largest players in that sector, with a managed care membership of 25.2 million people, with roughly half of them enrolled in Medicaid plans.

Centene said that it expects the Magellan deal to bring in 5.5 million members on government-sponsored plans, 2 million members of Magellan’s pharmacy benefit manager plans, and a behavioral health platform with 41 million members, among other businesses.

“This acquisition accelerates our diversification strategy and enhances our ability to build next generation capabilities in our specialty care business by leveraging our scale and investments in technology,” said Centene CEO Michael Neidorff in a statement.

In an interview with Barron’s on Monday morning, Neidorff said that he chiefly wanted Centene to have access to Magellan’s behavioral-health network, which contracts with states, employers, and other insurers to offer various behavioral health care services.

Behavioral health is probably the most underserved area,” Neidorff said. “This gives us access to a very broad network… It gives them access to our technology.”

Neidorff said that Magellan will be treated as an independent company within Centene, and that outside clients will have equal access to its behavioral-health product.

“If you have a newly diagnosed diabetic, after they see their endocrinologist, they should go see a psychologist to help them deal with it,” Neidorff said. “You end up with better compliance and a healthier situation.”

Neidorff said that he expects the deal to close in the second half of the year.

On an analyst call Monday, Neidorff said that regulatory approval for the deal wouldn’t pose a major challenge. “It’s complex, but it’s something we’re very used to. We’ve had some that are far more complex,” Neidorff said. “I don’t anticipate any divestitures.”

Magellan recently sold off its Magellan Complete Care business, which offers Medicaid and Medicare plans in certain states, to Molina Healthcare (MOH) for $820 million. Molina Healthcare announced Monday that the transaction closed last Thursday.

In the interview with Barron’s, Neidorff said that the sale of that business was necessary to allow regulatory clearance of the deal.

The immediate reaction to the deal from Wall Street analysts appears to be positive. In a note out early Monday, Cantor Fitzgerald analyst Steven Halper said the transaction looked good for Centene.

“We believe [Magellan Health] is a solid acquisition with modest near term accretion,” Halper wrote. “The company’s leverage ratios will certainly increase again, but given a relatively low cost of capital, the company should be able to drive incremental returns.”

Shares of Centene were down 1.8% over the past 12 months, as of Friday’s close. The stock trades at 11.4 times expected earnings over the next 12 months, according to FactSet, below its five-year average of 14 times earnings. Of the twenty-one analysts who cover the stock tracked by FactSet, 19 rate it a Buy or Overweight, while two rate it a Hold.

Clipped from: https://www.barrons.com/articles/centene-is-climbing-on-its-plans-to-buy-magellan-health-for-2-2-billion-51609771065