A jury has convicted the owner of a chain of assisted living facilities of 20 charges related to violation of resident rights for profit. Philip Esformes faces the possibility of living out his life behind bars for the conviction in what is being called the largest healthcare fraud case the United States Justice Department has ever charged.
The Largest Healthcare Scheme in U.S. History
Though not yet formally sentenced, Esformes is facing several decades behind bars for his crimes in this historic conviction. The charges against him include:
- Paying and receiving kickbacks
- Money laundering
- Conspiracy to commit federal program bribery
- Defrauding Medicare and Medicaid of $1.3 billion
Though the jury did not actually convict him on the defrauding charge specifically, the remaining charges for his repeated and flagrant violation of assisted living resident rights are enough to leave Esformes in prison for the rest of his natural life. He has been held behind bars without the possibility of bail since 2016.
Prosecutors referred to Esformes throughout his trial as a “parasite” motivated by “unbounded greed” as they unraveled his exploitation and victimization of the residents in his facilities.
More shocking than all the money he allegedly stole from federal aid programs are the poor conditions allowed to fester in his chain of facilities. Residents received inadequate medical care and were unfairly or illegally shuffled between care facilities.
The Fraud Scheme and Violations of Resident Rights
Esformes’s deplorable practices carried on for 18 years, from 1998 to 2016. His cycle of violating his residents’ rights:
- Bribing doctors or hospital administrators to admit patients to his facilities.
- Cycling residents through his network of 16 long-term care and assisted living facilities.
- Treating residents with medically unnecessary services, inadequate care, and sometimes no care at all.
- Bribing a Florida state nursing home regulator to give notice of surprise inspections, effectively hiding the poor conditions and abuses in his facilities.
During the eight-week trial, prosecutors accused Esformes of using the profits from fraudulently charged Medicare and Medicaid payments to purchase extravagant personal items, such as luxury cars and a watch worth more than $350,000. He also allegedly bribed a school official to get his son admitted to an Ivy League school. In the end, Esformes personally pocketed $37 million while residents in his facilities suffered unthinkable abuse and neglect.
A Business Culture of Trampling Resident Rights?
Far from acting alone, Esformes could not have carried out his reign of terror on the vulnerable elderly without help. Not only did he have two co-conspirators also convicted for related crimes, but was he aided and abetted by those who accepted his bribes and those who actually performed the abusive and negligent behaviors.
His 2 co-conspirators are physician’s assistant, Arnaldo Carmouze, and former hospital administrator, Odette Barcha. They assisted Esformes by:
- Illegally or inappropriately admitting patients to Esformes’s facilities.
- Billing Medicare and Medicaid inappropriately for services since at least 2002.
- Receiving kickbacks for sending patients to mental health and other care providers who also performed unnecessary treatments on the vulnerable elderly.
- Hiding these kickbacks as charitable donations or mislabeling them as other sham fees.
The trio went so far as to ruthlessly cycle patients nearing Medicare stay limits through other corrupt providers, both prolonging the suffering of the residents, and liberally dispensing bribes and kickbacks in their relentless pursuit of income.
Incredibly, Esformes paid $15.4 million in 2006 to resolve federal healthcare fraud claims in civil court for what Justice Department officials described as “essentially identical conduct.” The criminal charges for which he was convicted this week represent more sophisticated and efficient ways to wring money from the suffering of nursing home residents.
The recent scheme was not limited merely to the elderly. Thousands of people shuffled through the corrupt network of facilities were actually drug addicts prescribed opioids and narcotics including OxyContin and Fentanyl. Staff members bribed these complicit victims with access to drugs to entice them to stay in facilities where they didn’t belong. The facility would then allegedly bill Medicaid and Medicare for unnecessary services.
Systemic Abuse is Nationwide
Though Esformes and his co-conspirators’ crimes are shocking, they reflect the profit-at-all-costs model by which many nursing homes across the nation operate. A common way that nursing home owners and administrators prioritize profits over patient care is understaffing or underpaying their staff.
The Centers for Medicare and Medicaid Services (CMS) has started grading nursing homes using payroll data to ensure that facilities are adequately staffed to meet the needs of residents. After implementing this metric, 1,400 nursing homes lost standing in ratings for inadequate staffing practices.
The data showed that for-profit nursing homes average 16 percent fewer staff members than nonprofit facilities. Regarding availability of registered nurses, average nonprofit facilities provided one RN for every 28 residents, compared to a disquieting one RN for every 43 residents in for-profit facilities. Currently, 70 percent of the nursing home industry is for-profit.
The data also showed that staffing can vary widely by the day of the week, which is badly inappropriate. Resident rights don’t disappear on the weekends, but staff members apparently do. The CMS payroll data shows:
- Nurses on staff decline by about 11 percent on average on the weekend.
- Other staff members are usually reduced by about 8 percent on the weekend.
- The average nursing home can have one licensed nurse caring for as few as 17 or as many as 33 residents depending on the day.
- Certified nursing assistants (CNAs) or other aides may need to care for as few as 9 or as many as 16 residents on average.
With these erratic levels of staff working day-to-day, residents can find themselves waiting hours to get help from a staff member who is swamped with the needs of too many residents at once.
Homes with low staffing tend to have more health code and other CMS violations. Over-tasked workers simply cannot provide quality care for nursing home residents. Lack of adequate staff can result in:
- Late or missed meals
- Missed calls for restroom assistance
- Missed calls for pain medication
- Inadequate repositioning to prevent bedsores
- Avoidable hospitalizations
The elderly are vulnerable and are at the mercy of profit-driven corporations in most nursing homes. Owners of many care facilities attempt to maximize profits by compromising the care and rights of their residents by understaffing, and this can easily result in abuse.
Nursing Home Resident Rights
Nearly 1.4 million people reside in skilled nursing facilities in the U.S. The Nursing Home Reform Act of 1987 established the “Nursing Home Resident Bill of Rights”, which outlines resident rights and protections, including:
- The right to be treated with respect and dignity
- The right to be informed about services and fees prior to entering the nursing home
- The right to manage their own money or choose a trusted proxy to do so
- The right to privacy, to have and use personal belongings as long as they don’t interfere with the rights of others
- The right to be informed about their medical condition and treatment
- The right to refuse treatment
- The right to choose you’re their daily schedule and participate in activities if they so choose
- The right to be free of abuse and neglect
- The right to protection against unfair or arbitrary transfer or discharge
Clearly, Esformes and his deplorable business practices routinely violated these practices for countless residents. The result is untold harm and possibly death to some of the most vulnerable members of our society.
Contact a Nursing Home Abuse Attorney for Help
Philip Esformes has a long history of nursing home abuse and violating resident rights. In addition to his prison sentence, he may face civil suits from the families of his victims now that the full extent of his wrongdoing is known.
All nursing home facilities must provide adequate care for their residents. When they fail to do so, and especially when they flagrantly violate resident rights, they can and should be made to pay for the pain and suffering they have caused.
If your or a loved one has experienced abuse or neglect of any kind in a nursing home, schedule a consultation with our attorneys at the Nursing Home Abuse Center. Our attorneys are passionate about protecting resident rights and holding the at-fault parties responsible for abuse or neglect. Call 1-800-516-4783 or contact us online.