Florida Health Administrator Charged in $1 Billion Fraud Case

Cash exchanged for confidential reports and schedules that were used for false claims

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

FierceHealthcare reported that 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 the Department of Justice. Blanco did not receive payouts directly from Esformes but through a series of intermediaries, the Miami Herald reported.

Esformes 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 health care facilities while exchanging kickbacks disguised in various sham agreements, as FierceHealthcare previously reported.

Blanco’s defense attorney Robyn Blake told the Herald that she is reviewing the Department of Justice’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 September 1.

Esformes’ attorneys maintain his innocence, according to the Herald. Two of 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.

Source: FierceHealthcare; July 31, 2017.