Florida health administrator charged in $1B fraud case


http://www.fiercehealthcare.com/finance/florida-health-administrator-charged-1b-fraud-case?utm_medium=nl&utm_source=internal&mrkid=959610&mkt_tok=eyJpIjoiTkdWbE16bGlOMlJrWWpKaSIsInQiOiJWYVwvZWxBWjZGWEREN3BuSHBkNGZHN3ZqUVJNcWVzTVEwRDk5TWV6OVBkQ1RoZGhuVmlRbXFWMmpVMFgyb1NhbDNDeEhtYUVaaEdJVXBZXC9MWEpqUlZcLzR6WU9kQkowUk5OS1hcL1BcL21oSnphRXMrOFwvOHRhekVyQ2dlbktSc2pLdiJ9

Dollars

Bribes paid to a state health administrator are central to one of the biggest healthcare fraud cases to date, according to federal authorities.

The Department of Justice has charged Bertha Blanco, a former employee at Florida’s Agency for Health Care Administration (AHCA) with bribery in connection with a $1 billion Miami fraud case. Federal investigators said Blanco received bribes from Philip Esformes, the CEO of a Miami chain of skilled nursing facilities and assisted-living facilities, and his associates.

Blanco received cash bribes from Medicare and Medicaid providers in exchange for confidential AHCA reports, including patient complaints and unannounced AHCA inspection schedules that were then used to make false Medicare and Medicaid claims, according to DOJ. Blanco did not receive payouts directly from Esformes but through a series of intermediaries, the Miami Herald reports.

Esformes, who made FierceHealthcare’s list of notorious healthcare executives last year, has been charged with fraud and bribery in the case. He has been behind bars in federal prison since July 2016 awaiting a trial set for March 2018.

Assistant Attorney General Leslie R. Caldwell called the scheme “ruthlessly efficient,” with conspirators using a network of corrupt providers to shuffle patients between various healthcare facilities while exchanging kickbacks disguised in various sham agreements, as FierceHealthcare has previously reported.

Blanco’s defense attorney Robyn Blake told the Herald that she is reviewing the DOJ’s evidence before deciding to pursue a full trial or take a plea deal. Blanco was arrested earlier this month and was released on $250,000 bond; she will be arraigned on Sept. 1.

Esformes’ attorneys maintain his innocence, according to the Herald. Two of the Esformes’ alleged co-conspirators have pleaded guilty to Medicare fraud charges, and Michael Pasano, Esformes’ lead attorney, said the pair worked independently without Esformes’  involvement.

Another fraud case: Vanderbilt Hospital settles overbilling suit

In other fraud news, Vanderbilt University Medical Center has paid out $6.5 million to settle a federal lawsuit that alleged the hospital overbilled Medicare and Medicaid, the Associated Press reports.

The suit was brought in 2013 by whistleblowers who claimed the hospital overbilled federal healthcare programs for more than a decade. Vanderbilt’s counsel, Michael Regier, said that the settlement aimed to avoid further costs and distractions related to the suit, according to the article, and that the hospital still disputes the claims in the lawsuit.

The hospital and the feds found no evidence of wrongdoing on Vanderbilt’s part, Regier said.

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