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Baton Rouge Doctor Sentenced to Prison for Fraudulent Billing Scheme


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Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Friday, May 17, 2019

Baton Rouge Doctor Sentenced to Prison for Fraudulent Billing Scheme

A Baton Rouge, Louisiana-based doctor was sentenced to 37 months in prison followed by two years of supervised release today for his role in a scheme to defraud Medicare and other health care insurers.  

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Brandon J. Fremin of the Middle District of Louisiana, Special Agent in Charge C.J. Porter of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Dallas Field Office and Special Agent in Charge Eric J. Rommal of the FBI’s New Orleans Field Office made the announcement. 

John Eastham Clark, M.D., 66, of Baton Rouge, was sentenced by Chief U.S. District Judge Shelly D. Dick of the Middle District of Louisiana, who also ordered Clark to pay $254,962.80 in restitution.  In February 2019, Clark pleaded guilty to one count of conspiracy to commit health care fraud. 

Clark was a co-owner and the medical director of Louisiana Spine & Sports LLC, a pain management clinic located in Baton Rouge.  The charge stems from Clark’s role in a scheme to submit fraudulent claims to Medicare and other health care insurers.  As part of his guilty plea, Clark admitted that from approximately June 2005 through March 2015, he, along with his billing supervisor Charlene Anita Severio and others, conspired to submit fraudulent claims indicating that minor surgical procedures occurred on days subsequent to office visits, when in fact the office visits and procedures took place on the same day.  Clark admitted that this practice, commonly referred to as “unbundling,” was done to defraud health care insurers for non-reimbursable office visits.  Clark further admitted to falsifying, and directing Severio and others to falsify, records substantiating the fraudulent claims.

In February 2019, Severio pleaded guilty to one count of conspiracy to commit health care fraud and wire fraud and two counts of health care fraud.  She is scheduled to be sentenced on May 22 by Chief Judge Dick.

In another case involving Louisiana Spine & Sports, on Nov. 20, 2018, Gray Wesley Barrow, M.D., a co-owner of the company, pleaded guilty for his role in a scheme to receive approximately $336,000 in illegal health care kickback payments.  Barrow is scheduled to be sentenced on June 7, 2019, by U.S. District Judge Brian A. Jackson of the Middle District of Louisiana.  In addition, Christopher William Armstrong, a former physician’s assistant at Louisiana Spine & Sports, pleaded guilty on Nov. 27, 2018 for his role in a scheme to unlawfully distribute thousands of oxycodone pills.  Armstrong is scheduled to be sentenced on June 24, 2019, by U.S. District Judge John W. deGravelles of the Middle District of Louisiana.  

The case was investigated by HHS-OIG and the FBI, and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Middle District of Louisiana.  Assistant Chief Dustin M. Davis and Trial Attorney Justin M. Woodard of the Fraud Section and Assistant U.S. Attorney Elizabeth E. White of the Middle District of Louisiana are prosecuting the case.  

The Medicare Fraud Strike Force is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.  In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.




Department of Justice
Office of Public Affairs

FOR IMMEDIATE RELEASE
Friday, April 5, 2019

South Florida Health Care Facility Owner Convicted for Role in Largest Health Care Fraud Scheme Ever Charged by The Department of Justice, Involving $1.3 Billion in Fraudulent Claims

A federal jury found a South Florida health care facility owner guilty today for his role in the largest health care fraud scheme ever charged by the Justice Department, involving over $1.3 billion in fraudulent claims to Medicare and Medicaid for services that were not provided, were not medically necessary or were procured through the payment of kickbacks. 

Assistant Attorney General Brian A. Benczkowski of the Justice Department’s Criminal Division, U.S. Attorney Ariana Fajardo Orshan of the Southern District of Florida, Special Agent in Charge George Piro of the FBI’s Miami Field Office, Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office and Deputy Administrator and Director Alec Alexander of the Centers for Medicare and Medicaid Services Center for Program Integrity made the announcement.



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After an eight-week trial, Philip Esformes, 50, of Miami Beach, Florida, was convicted of one count of conspiracy to defraud the United States, two counts of receipt of kickbacks in connection with a federal health care program, four counts of payment of kickbacks in connection with a federal health care program, one count of conspiracy to commit money laundering, nine counts of money laundering, two counts of conspiracy to commit federal program bribery, and one count of obstruction of justice before U.S. District Judge Robert N. Scola Jr. of the Southern District of Florida.  Sentencing has not yet been scheduled.


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“Philip Esformes orchestrated one of the largest health care fraud schemes in U.S. history, defrauding Medicare and Medicaid to the tune of over a billion dollars,” said Assistant Attorney General Benczkowski.  “I commend our dedicated prosecutors and law enforcement partners for their professionalism and unyielding pursuit of justice on behalf of American taxpayers and vulnerable beneficiaries who, as a result of Esformes’s crimes, were denied the level of care that they needed and deserved.”



    
   
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“Philip Esformes’ criminal scheme defrauded America’s health care system out of millions of dollars, that would have otherwise provided quality care to patients in need,” said U.S. Attorney Fajardo Orshan.  “I commend the Assistant U.S. Attorneys from the Southern District of Florida, who worked tirelessly alongside their partners at the Department’s Criminal Division, the FBI and HHS-OIG to bring this case to justice.  This massive fraud scheme, perpetuated in nursing and assisted living facilities in our South Florida communities, compromised the integrity of our local health care system.  We remain united in our commitment to root out health care fraud and support quality patient care.”

“Philip Esformes is a man driven by almost unbounded greed,” said Assistant Special Agent in Charge Denise M. Stemen of FBI Miami.  “The illicit road Esformes took to satisfy his greediness led to over $800 million in fraudulent health care claims, the largest amount ever charged by the Department of Justice.  Along that road, Esformes cycled patients through his facilities in poor condition where they received inadequate or unnecessary treatment, then improperly billed Medicare and Medicaid.  Taking his despicable conduct further, he bribed doctors and regulators to advance his criminal conduct and even bribed a college official in exchange for gaining admission for his son to that university.  The FBI and its partners are constantly investigating health care fraudsters, big and small, who steal money from taxpayers at the expense of patients in need of quality medical care.”



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“This largest ever healthcare fraud conviction highlights the awful toll criminal schemes take on federal health programs,” said HHS-OIG Special Agent in Charge Richmond.  “Even beyond the vital dollars lost though, Esformes exploited and victimized patients by providing inadequate medical care and poor conditions in his nursing homes.  Along with our law enforcement partners, we will continue the fight against such parasites.”

According to evidence presented at trial, from approximately January 1998 through July 2016, Esformes led an extensive health care fraud conspiracy involving a network of assisted living facilities and skilled nursing facilities that he owned.  Esformes bribed physicians to admit patients into his facilities, and then cycled the patients through his facilities, where they often failed to receive appropriate medical services, or received medically unnecessary services, which were then billed to Medicare and Medicaid, the evidence showed.  Several witnesses testified to the poor conditions in the facilities and the inadequate care patients received, which Esformes was able to conceal from authorities by bribing an employee of a Florida state regulator for advance notice of surprise inspections scheduled to take place at his facilities.  The evidence further showed that Esformes used his criminal proceeds to make a series of extravagant purchases, including luxury automobiles and a $360,000 watch.  Esformes also used criminal proceeds to bribe the basketball coach at the University of Pennsylvania in exchange for his assistance in gaining admission for his son into the university.  Altogether, the evidence established that Esformes personally benefited from the fraud and received in excess of $37 million. 



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Esformes’s coconspirator, physician’s assistant Arnaldo Carmouze, previously pleaded guilty to conspiracy to commit health care fraud and is scheduled to be sentenced on April 10.  Esformes’s coconspirator Odette Barcha also pleaded guilty to one count of conspiring to violate the anti-kickback statute.  Barcha was sentenced on April 3 to serve 15 months in prison followed by three years of supervised release.  She was also ordered to pay $704,516.00 in restitution.

This case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, under the supervision of the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida with assistance from Florida Attorney General’s Office Medicaid Fraud Control Unit  The case was prosecuted by Fraud Section Assistant Chiefs Allan Medina and Drew Bradylyons and Trial Attorneys James Hayes, Elizabeth Young and Jeremy Sanders, as well as Assistant U.S. Attorneys John Shipley and Dan Bernstein of the Southern District of Florida.  Assistant U.S. Attorneys Alison Lehr, Nalina Sombuntham and Daren Grove of the Southern District of Florida are handling the forfeiture aspects of the case.





The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between the Department of Justice and HHS to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the country.  Since its inception in March 2007, the Medicare Fraud Strike Force, which maintains 14 strike forces operating in 23 districts, has charged nearly 4,000 defendants who have collectively billed the Medicare program for more than $14 billion.






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