Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 1 of 57
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`U NITED STA TES DISTR ICT C O U R T
`SO UTH E RN D ISTRIC T O F FLO RIDA
`
`C ase N o. 16-C R -20549-SC O LA (s)(s)(s)
`18 U.S.C. j 1349
`18 U.S.C. j 1347
`18 U.S.C. j 1035
`18 U.S.C. j 371
`42 U.S.C. j 1320a-7b(b)(1)(A)
`42 U.S.C. j 1320a-7b(b)(2)(A)
`18 U.S.C. j 1956(h)
`18 U.S.C. j 1956(a)(1)(B)(i)
`18 U.S.C. j 666
`18 U.S.C. j 1343
`18 U.S.C. j 1346
`18 U.S.C. j 1503
`18 U.S.C. j 2
`18 U.S.C. j 981
`18 U.S.C. j 982
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`FILED by '' D.c.
`
`JUL 1 8 2213
`
`sTqvEN M LARIMJR:CLERK U è DIST
`
`cT
`s, D. of FLX. -MA I
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`U NITED STATE S O F A M ER ICA
`
`VS.
`
`PH ILIP ESFO RM ES,
`O D ETTE BA R CH A , and
`AR NA LD O CA R M O U ZE ,
`
`Defendants.
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`/
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`TH IR D SU PER SE DIN G IN DIC TM E NT
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`The Grand Jtlry charges that:
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`G EN ER AL A LLE G A TIO N S
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`At all tim es relevant to this Third Superseding lndictm ent,
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`The H eaIth Insurance Proeram s
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`The M edicare Program CiM edicare'') was a federal health care program providing
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`benefits to persons who w ere 65 or older or disabled. M edicare w as adm inistered by the United
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`States Department of Hea1th and Human Services (ttHHS'') through its agency, the Centers for
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`

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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 2 of 57
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`M edicare & M edicaid Services (<fCM S''). lndividuals who received benefits under M edicare were
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`referred to as M edicare ç<beneficiaries.''
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`The Florida M edicaid Program (tiM edicaid'') provided benefits to certain low-
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`incom e individuals and fam ilies in Florida. M edicaid w as adm inistered by CM S and the A gency
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`for Hea1th Care Administration (<W HCA''). M edicare and M edicaid were each a ççhealth care
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`benefh propam,'' as defined by Title 18, United States Code, Section 24(b), and a ttfederal health
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`care program,'' as defined by Title 42, United States Code, Section 1320(a)-7(b)-f
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`The M edicare prop am w as divided into four çtparts'' that cover different services.
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`M edicare Part A generally covers inpatient hospital services, hom e health and hospice care, and
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`skilled nursing and rehabilitation care.
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`4.
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`Subject to certain conditions, M edicare Part A covered up to 100 days of skilled
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`nursing and rehabilitation care for a benefit period (i.e., spell of illness) following a qualifying
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`hospital stay of at least tlu'ee consecutive days. 42 U.S.C. j 1395d(a)(2)(A); 42 C.F.R.
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`j 409.6109, (c).
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`5.
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`The conditions that M edicare imposed on its Part A skilled ntlrsing facility (ç%SNF'')
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`benefit included: (1) that the patient required skilled nursing care or skilled rehabilitation services
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`(or both) on a daily basis, (2) that the daily skilled services must be services that, as a practical
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`matter, could only be provided .in a skilled nursing facility on an inpatient basis, and (3) that the
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`services w ere provided to address a condition for w hich the patient received treatm ent during a
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`qualifying hospital stay or that arose w hile the patient w as receiving care in a skilled nursing
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`facility (for a condition treated dudng the hospital stay). 42 U.S.C. j 1395f(a)(2)(B); 42 C.F.R. j
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`409.31(b).
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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 3 of 57
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`M edicare required that a physician or certain other practitioners certify that these
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`conditions w ere m et at the tim e of a patient's adm ission to the nursing facility and to re-certify to
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`the patient's continued need for skilled rehabilitation therapy services at regular intervals
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`thereaRer. See 42 U.S.C. j 1395f(a)(2)(B); M edicare General lnformation, Eligibility, and
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`Entitlement M anual, Ch. 4, j 40.3.
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`To assist in the adm inistration of M edicare Part A , CM S contracted w ith çtfiscal
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`intermediaries.'' 42 U.S.C. j 1395h. Fiscal intermediaries, typically insurance companies, were
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`responsible for processing and paying claim s and cost reports.
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`8.
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`Beginning in or around N ovem ber 2006, M edicare Adm izlistrative Contractors
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`began replacing both the caniers and fiscal intermediaries. See Fed. Reg. 67960, 68181 (Nov.
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`2006). The M ACS generally acted on behalf of CM S to process and pay Part A (as well as
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`M edicare Part B) claims and perform administrative functions on a regional level. See 42 j C.F.R.
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`421.5(b).
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`In Florida, First Coakt Service Options, lnc. CçFirst Coasf') served as the fiscal
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`interm ediary and carrier until Septem ber 2008, at which tim e it w as aw arded a contract to serve as
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`the M A C for the Florida region.
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`10.
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`Providers w ho w ished to be eligible to participate in M edicare Part A w ere
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`requested to periodically sign an application form , CM S Form 855A .The application, which w as
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`required to be sir ed by an authorized representative of the provider, contained a certification that
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`stated:
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`I agree to abide by the M edicare laws, regulations, and program
`instructions that apply to this provider. The M edicare law s,
`regulations, and program instructions are available through the
`M edicare contractor. l understand that paym ent of a claim by
`M edicare is conditioned upon the claim and the underlying
`transaction com plying w ith such law s, regulations and program
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`

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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 4 of 57
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`instructions (including, but not limited to, the federal anti-kickback
`statute and the Stark law), and on the provider's compliance with a11
`applicable conditions of participation in M edicare.
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`CM S Form 855A contained additional certitk ations that the provider ççw ill not
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`know ingly present or cause to be presented a false or fraudulent claim for paym ent by M edicare
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`and w ill not subm it claim s w ith deliberate ignorance or reckless disregard of their truth or falsity.''
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`Every SN F cost report contained a ççcertification'' that m ust be sip zed by the chief
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`administrator of the provider or a responsible desib ee of the administrator.
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`SN FS subm itted the CM S-1450 electronically under M edicare Part A to their local
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`fiscal interm ediary or M A C, w hich in this case w as First Coast. First Coast, on behalf of CM S,
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`processed and paid the M edicare Part A claim s.
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`14.
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`ln addition to the services covered under M edicare Part A , M edicare Part B
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`provided coverage for, am ong other things, certain physician office and hom e visits, and other
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`health care benefits, item s, and services. The physician services at issue in tlzis Third Superseding
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`lndictm ent w ere cùvered by Part B.
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`15. A n çW ssisted Living Facility'' or CW LF'' w as a facility licensed by A H CA , w hether
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`operated for profit or not, which undertook tlzrough its ow nership or m anagem ent, to provide
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`housing, m eals, and one or m ore personal services for a period exceeding 24 hours to one or m ore
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`adults who w ere not relatives of the ow ner or adm inistrator. M edicaid covered a portion of certain
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`costs associated w ith A LF stays.
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`ln Florida, A HCA w as responsible for adm inistering the M edicaid program , and
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`was tasked w ith regulating and licensing health care facilities in Florida, including SN FS and
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`A LFS. A H CA w as funded by both the state and federal govem m ents. A H CA received benetks in
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`4
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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 5 of 57
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`excess of $10,000 each year from the federal governm ent at a11 tim es relevant to the Third
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`Superseding lndictm ent.
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`17. AHCA'S Division of Health Quality Assurance investigated patient complaints and
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`conducted unarm ounced inspections of a w ide range of health care facilities in the state of Florida,
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`including A LFS and SN FS. ln connection w ith these duties, A H CA surveyors entered and
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`inspected health care facilities to review clinical records, interview patients, and interview staff,
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`am ong other things, to ensure that the providers w ere com plying w ith applicable state and federal
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`statutes in a m anner that protected the health and safety of the patients.
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`18. If A H CA surveyors identified deficiencies or fraud during their inspections, they
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`could fine or, ultim ately, revoke the operating license of the facility. The surveyors also notified
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`the Florida M edicaid Fraud Control Unit at the Florida Attorney G eneral's O ftk e if they observed
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`evidence of fraud.
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`The D efendants. R elated Com panies and Individuals
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`Defendànt PH ILIP ESFO RM ES, a resident of M iam i-Dade County, controlled,
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`owned, or operated the following SNFSand ALFS (collectively referred to as the ttEsfonnes
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`Network'), located throughout M iami-Dade County,
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`in the Southern D istrict of Florida, and
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`elsew here:
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`Facility N am e
`A D M E lnvestm ent Partners LTD dba
`Oceanside Extended Care
`Alm ovea A ssociates LLC dba N orth D ade N ursing and
`Rehabilitation Center
`Ayintove A ssociates LLC dba
`H arm on H ealth Center
`Courtyard M anor Retirem ent Living, Inc.
`Eden Gardens LLC
`Fair Havens Holding LLC/Fair H avens Center LLC
`Flam ingo Park M anor LLC/TIAe Pointe
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`Type of Facility
`SN F
`
`SN F
`
`SN F
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`A LF
`A LF
`SN F/A LF
`A LF
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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 6 of 57
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`Facility N am e
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`Type of Facility
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`La Covadonga
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`Lake Ersw in LLC dba South H ialeah
`M anor/lnteram erican
`K abirhu A ssociates LLC dba G olden Glades N ursing and
`Rehabilitation Center
`Lauderhill M anor LLC
`1.,a Serena R etirem ent Living LLC/La H acienda
`G ardens/Rainbow
`Jene's Retirem ent Living, Inc./lene's Retirem ent Investors
`Ltd dba N orth M iam i Retirem ent Livin
`Sefardik A ssociates, LLC dba
`The N ursin Center at M erc
`Takifhu A ssociates LLC dba South D ade N ursing and
`Rehabilitation Center
`W illiam sburg Retirem ent Living
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`A LF
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`A LF
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`SN F
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`A LF
`A LF
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`A LF
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`SN F
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`SN F
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`A LF
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`20. D efendant PH ILIP ESFO R M E S also ow ned, controlled, and/or m anaged a
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`num ber of com panies that purportedly m anaged the Esform es N etw ork, including: A dirhu
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`A ssociates LLC , A LF Holdings, Inc., La Covadonga Retirem ent Living, lnc., Fam ily R est
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`M anagement, M orsey LC, and M orphil Corporation (collectively referred to as the GçEsformes
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`M ahagement Companies'), located throughout M iàmi-Dade County, in thù Southem District of
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`Florida, and elsewhere.
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`21. D efendant O D ETTE BA R CH A , a resident of M iam i-Dade C ounty, w as the
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`registered agent and director of Barcha Consulting,lnc. (tçBarcha Consultinf), a Florida
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`cop oration, and w as the D irector of O utreach Program s at H ospital 1.
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`22. Defendant AR N A LD O CA R M O UZE , a resident of M iam i-Dade County, w as a
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`physician's assistant CTA'') licensed in the State of Florida.
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`23. Guillerm o Delgado w as a resident of M iam i-Dade County.
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`Gabriel D elgado w as a resident of M iam i-D ade County.
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`D iversitied lnvestm ent Group of M iam i, lnc., D iversified M edical G roup, La
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`Covadonga M anagem ent Group LLC, and Preferred Providers Group, lnc., w ere Florida
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`6
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`

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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 7 of 57
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`corporations ow ned and controlled by Guillerm o and Gabriel D elgado.
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`Guillenno D elgado and G abriel Delgado ow ned, controlled and/or operated Tender
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`Touch Home Hea1th LLC (çtTender Touch'') and St. Jude Hea1th Care, Inc. (ç<St. Jude''), Florida
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`corporations.
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`27. N elson Salazar, a resident of M iam i-D ade County, w as the owner of N ursing
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`Unlimited 2000, Inc. (EENlzrsing Urllimited'), a Florida corporation.
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`28. Jose Carlos M orales, a resident of M iam i-D ade County, was the ow ner of
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`Pharmovisa, Inc. and Pharmovisa, MD, Inc. (collectively ççphannovisa'), Florida corporations.
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`29.
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`Pharm acy 1, Pharm acy 2, and Pharm acy 3 w ere pharm acies in M iam i-Dade
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`County.
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`30.
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`Am erican Therapeutic Corporation and Greater M iam i Behavioral H ea1th Care
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`Center, lnc. (tr reater M iami'') were partial hospitalization programs in M iami-Dade County.
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`Diar ostic Com pany 1, D iagnostic Com pany 2, D iagnostic Com pany 3, D iagnostic
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`Companf 4, and Diagnostic Conipany 5, were diagnostié companies in M iami-Dade and Broward
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`Counties.
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`32.
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`Hospital 2 was a hospital in M iam i-D ade County.
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`33. Laboratory 1 w as a laboratory in M iam i-D ade County.
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`34. Physician V ision G roup 1 w as a group of vision physicians in M iam i-D ade Cotm ty.
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`35. Physician 1 w as a resident of M iam i-D ade County and w orked w ith A R N AI,D O
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`CA R M O U ZE .
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`36. Fem ale Com panion 1 w as a resident of M iam i-Dade County.
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`37.
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`Fem ale Com panion 2 w as a resident of M iam i-Dade County.
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`38.
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`Fem ale Com panion 3 w as a resident of Brow ard County.
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`7
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`Fem ale Com panion 4 was a resident of M iam i-D ade County.
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`40.
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`Fem ale Com panion 5 was a resident of M iam i-D ade County.
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`41.
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`Personal A ssistant 1 was a resident of M iam i-D ade County.
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`42.
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`Basketball Coach 1 w as a resident of Houston, Texas, in Hanis County.
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`43. Basketball Coach 2, a resident of Philadelphia, Perm sylvai a, in Pennsylvania
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`County, w as em ployed as the head m en's basketball coach at U niversity 1 betw een approxim ately
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`D ecem ber 1, 2009 and M arch 31, 2015.
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`44. lndividual 1 w as a resident of M iam i-D ade County.
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`45. U niversity 1 w as a tm iversity in Philadelphia, Pennsylvania, in Pennsylvania
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`County, that received federal benefits in excess of $10,000 within a one-year period under a
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`Federal proc am involving a r ant, contract, subsidy, or other form of Federal assistance at a11
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`tim es relevant to the Third Superseding Indictm ent.
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`46. N ursing H om e A dm inistrator 1 w as a resident of M iam i-D ade County.
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`CO UN T 1
`C onspiracy to C om m it H ealth C are Fraud and W ire Fraud
`(18 U.S.C. j 1349)
`
`Paragraphs 1 through 40, 42, and 46 of the G eneral A llegations section of this Third
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`Superseding Indictm ent are re-alleged and incorporated by reference as though fully set forth
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`herein.
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`2.
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`From in or around January 1998, and continuing through in or around July 2016, in
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`(M iam i-Dade County, in the Southern D istrict of Florida, and elsewhere, the defendants,
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`PH ILIP ESFO RM ES,
`O DE TTE BA RC H A ,
`and
`A R NA LD O CA R M O U Z E,
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`8
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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 9 of 57
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`did willfully, that is, with the intent to further the objects of the conspiracy, and knowingly
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`com bine, conspire, confederate, and agree w ith Guillerm o D elgado, Gabriel D elgado, N elson
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`Salazar, Jose Carlos M orales, each other, and others known and unknow n to the G rand Jury, to
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`com m it certain offenses against the United States, that is:
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`a.
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`to know ingly and w illfully execute a schem e and artifice to defraud a health
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`care benefit prov am affecting com m erce, as defined in Title l 8, U nited States Code, Section
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`2409, that is, M edicare and M edicaid, and to obtain, by means of materially false and fraudulent
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`pretenses, representations, and prom ises, m oney and property ow ned by, and under the custody
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`and control otl said health care benefit program s, in connection with the delivery of and paym ent
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`for health care benefits, item s, and services, in violation of Title 18, United States Code, 1347; and
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`b.
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`to know ingly and w ith the intent to defraud, devise and intend to devise a
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`schem e and artifice to defraud, and for obtaining m oney and property by m eans of m aterially false
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`and fraudulent pretenses, representations, and prom ises, know ing that the pretenses,
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`representations, and prom ises were false aizd fraudulent w hen m ade, and did knowingly tiunsm it
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`and cause to be transm itted, by m eans of w ire com m dlnication in interstate com m erce, writings,
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`sir s, signals, pictures, and sounds for the purpose of executing such schem e and artifice, in
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`violation of Title 18, United States Code, Section 1343.
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`Purpose of the Conspiracv
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`3.
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`It w as a purpose of the conspiracy for the defendants and their co-conspirators to
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`unlawfully enrich thelnselves by, am ong other things: (a) submitting false and fraudulent claim s
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`to M edicare and M edicaid for claims based on kickbacks and bribes; (b) submitting and causing
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`the subm ission of false and fraudulent claim s to M edicare and M edicaid for services that were
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`m edically unnecessary, that w ere not eligible for M edicare and M edicaid reim bursem ent, and that
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`were neverprovided; (c) concealing the subm ission of false and fraudulent claim s to M edicare and
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`9
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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 10 of 57
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`Medicaid; and (d) diverting proceeds of the fraud for the personal use and benefit of the defendants
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`and their co-conspirators in the form of com pensation and other rem uneration.
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`M anner and M eans
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`The m anner and m eans by w hich the defendants and their co-conspirators sought to
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`accom plish the purpose of the conspiracy included, am ong others, the follow ing:
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`4.
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`PH IL IP E SFO R M ES ow ned and operated the Esform es N etw ork, which gave
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`him access to thousands of M edicare and M edicaid beneficiaries.
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`PH ILIP E SFO R M ES and co-conspirators negotiated and paid lcickbacks to
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`A RN ALD O C A R M O UZE, O D E TTE BA R C H A and certain m edical professionals in exchange
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`for referrals to the Esform es N etwork and co-conspirators.
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`6.
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`PH IL IP ESFO R M E S, tlzroug,h a shell com pany ow ned and/or controlled by
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`G abriel Delgado, caused the pam ent of kickbacks to O DE TTE BA RC H A .
`
`PH IL IP E SFO R M E S, O D ET TE BA R CH A , A R NA LD O CA R M O UZE , and
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`ùthers caused patients tö be adm itted into the Eâform es N etw ork, regardless of whether or not the
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`patients actually needed the services.
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`8.
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`PH ILIP ESFO RM ES, O D ETTE BA RC H A , A RN A LD O C A RM O U ZE, and
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`others recruited patients from a num ber of facilities ow ned or operated by ESFO RM E S in M iam i-
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`D ade, Osceola and Orange Counties, including: . Terrace of K issim m ee, Terrace of St. Cloud, H obe
`
`Sound and Fountain M anor.
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`Som e of the able-bodied patients that PH ILIP ESFO R M ES, O D ETTE
`
`BA R CH A, A R N ALD O CA R M O UZE , N ursing H om e A dm inistrator 1, and others caused to be
`
`adm itted to Esform es N etw ork SN FS who did not need skilled nursing services suffered from
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`psychiatric conditions that m ade them dangerous to elderlypatients also residing in these facilities.
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`10
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`

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`This led to incidents w here physical violence w as com m itted against elderly patients at Esfonnes
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`N etw ork SN FS. Even after these acts of violence occurred, ESFO RM ES, BA RC H A ,
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`CA R M O U ZE , Nursing H om e A dm inistrator 1, and others continued to cause patients w ith
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`psychiatric conditions w ho did not need skilled nursing senrices to be adm itted to Esform es
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`N etwork SN FS.
`
`10. PH ILIP ESFORM ES, ODETTE BARCH A ARNA LDO CARM O UZE, and
`
`others caused M edicare to be billed for purported physician and physician assistant visits and
`
`services rendered in the Esform es N etwork SN FS and A LFS that did not take place, including
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`services that w ere purportedly provided to M edicare beneficiaries aAer they had died.
`
`1 1. PH ILIP E SFO R M E S, N elson Salazar, G uillerm o Delgado, G abriel D elgado, and
`
`others created and caused to be created false and fraudulent invoices for durable m edical
`
`equipm ent, which w ere subm itted to D iversitied M edical Group for paym ent, and used the funds
`
`to pay kickbacks and bribes to physicians and other m edical professionals in exchange for referrals
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`to thé Esform es N etwork and co-conspirators.
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`On or about June 15, 2004, A R N AI,D O C A RM O U ZE certified to M edicare that
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`he w ould com ply w ith a1l M edicare rules and regulations, including that he w ould refrain from
`
`violating the federal A nti-M ckback statm e.
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`13. On or about O ctober 18, 2006, PH ILIP E SFO R M E S signed a civil settlem ent .
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`agreem ent w ith the U nited States Departm ent of Justice, resolving allegations in the Civil Law suit
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`that he, and others, paid kickbacks to a physician to adm it M edicare and M edicaid patients from
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`the Esform es N etw ork into H ospital 1 where they received urm ecessary services, w ithout
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`acknow ledging the validity of the claim s alleged by the U nited States or adm itting liability.
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`14. O n or about Septem ber 28, 2009, and again on or about January 1, 2012, PH ILIP
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`11
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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 12 of 57
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`E SFO R M ES certifed to M edicare that H arm ony Hea1th Center SN F w ould com ply w ith al1
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`M edicare rules and regulations, including that he and Harm ony Health Center SN F w ould refrain
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`from violating the federal A nti-M ckback statute.
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`15. O n or about February 2, 201 1, and again on or about M arch 22, 201 1, PH ILIP
`
`ESFO R M ES certified to M edicare that Fair Havens SN F would com ply w ith a11 M edicare rules
`
`and regulations, including that he and Fair H avens SN F w ould refrain from violating the federal
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`A nti-M ckback statute. O n or about July 10, 2006, June 25, 2010, M ay 22, 2012 and June 30,
`
`2015, ESFO R M ES certified to M edicaid that Fair H avens SN F w ould com ply w ith a11 M edicaid
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`rules and regulations, including that he and Fair Havens SNF w ould refrain from violating federal
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`laws.
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`16. 0 n or about January 24,2014, and again on or about A plil 3, 2014, PH ILIP
`
`ESFO R M ES certified to M edicare that The N ursing Center at M ercy SN F w ould com ply with a11
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`M edicare rules and regulations, including that he and The N lzrsing Center at M ercy SN F w ould
`
`refrain frôm violating the federàl Anti-M ckback stattite. On or about Febiuary 22, 2012,
`
`E SFO RM E S certified to M edicaid that The N ursing Hom e at M ercy SN F w ould com ply with a1l
`
`M edicaid rules and regulations, including that he and the N ursing Hom e at M ercy SN F w ould
`
`refrain from violating federal law s.
`
`O n or about D ecem ber 5, 201 1, and again on Septem ber 15, 2014, PH ILIP
`
`ESFO R M ES certified to M edicaid that O ceanside Extended Care SN F w ould com ply w ith a11
`
`M edicaid rules and regulations, including that he and O ceanside Extended Care SN F w ould refrain
`
`from violating federal law s.
`
`18. On or about N ovem ber 6, 2014, PH ILIP E SFO R M E S certified to M edicaid that
`
`N orth D ade N ursing and Rehabilitation Center SN F w ould com ply with all M edicaid rules and
`
`12
`
`

`

`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 13 of 57
`
`regulations, including that he and N orth Dade N ursing and R ehabilitation Center SN F w ould
`
`refrain from violating federal law s.
`
`19. On or about August 24, 2010, and again on or about July 19, 2013, PH IL IP
`
`E SFO RM ES certified to M edicaid that C ourtyard M anor A LF w ould com ply w ith a1l M edicaid
`
`rules and regulations, including that he and Courtyard M anor A LF w ould refrain from violating
`
`federal law s.
`
`20. On or about Septem ber 1, 2009, and again on or about Jtm e 12, 2012, and A ugust
`
`10, 2015, PH ILIP E SFO R M ES certitied to M edicaid that Flam ingo Park M anor A LF would
`
`com ply with a11 M edicaid rtzles and regulations, including that he and Flam ingo Park M anor A LF
`
`w ould refrain from violating federal law s.
`
`21. O n or about Septem ber 1, 2009, and again on or about July 18, 2012, PH ILIP
`
`ESFO R M ES certified to M edicaid that La H acienda G ardens A LF w ould com ply w ith a11
`
`M edicaid nzles and regulations, including that he and La H acienda G ardens A LF w ould refrain
`
`from violating federal law s.
`
`22. On or about Decem ber 10, 2013, PH ILIP E SFO R M E S certified to M edicaid that
`
`Lauderhill M anor A LF would com ply with a1l M edicaid rules and regulations, including that he
`
`and Lauderhill M anor A LF w ould refrain from violating federal law s.
`
`.
`
`23. .prior to, and aRer, signing each of these certifications to M edicare and M edicaid,
`
`PH ILIP E SFO RM ES paid kickbacks to physicians in exchange for their referral of M edicare and
`
`M edicaid beneficiaries to be placed at H arm ony H ea1th Center, Fair Havens, the Nursing Center
`.
`
`ide Extended Care
`at M ercy
`, and other SN FS. ESFO R M E S also received kickbacks prior
`, Oceans
`
`to, and after, signing each of these certitications for access to patients residing in those SN FS,
`
`Courtyard M anor
`,
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`Lauderhill M anor, Flam ingo Park M anor, La H acienda G ardens, and other
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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 14 of 57
`
`facilities in the Esform es N etw ork.
`
`24. PH ILIP ESFO R M E S caused H arm ony Health Center, Fair H avens, The N ursing
`
`Center at M ercy and other SN FS tm der his control to tile claim s to M edicare and M edicaid for
`
`skilled nlzrsing services for patients that w ere obtained through the paym ent of kickbacks to
`
`physicians.
`
`25. C o-conspirators paid PH ILIP ESFO RM E S kickbacks, bribes, and other
`
`inducements, often through Guillermo and Gabriel Delgado, in exchange for referrals of M edicare
`
`and M edicaid beneficiaries that w ere part of the Esform es N etwork. These co-conspirator
`
`providers included: Tender Touch, St. Jude, N tlrsing Unlim ited, Pharm ovisa, Pharm acy 1,
`
`Phannacy 2, Pharm acy 3, A m erican Therapeutic Corporation, Greater M iam i, D iagnostic
`
`Com pany 1, D iagnostic Com pany 2, Diagnostic Com pany 3, D iagnostic Com pany 4, and
`
`D iagnostic Com pany 5
`, Laboratory 1, Physician Vision Group 1, and other providers.
`
`26. PH ILIP E SFO R M E S received the kickbacks and bribes from the co-conspirators
`
`.
`
`which were disguijed as: a) cash paymeùts; b) payments to Fdmale Companion 1, Female
`
`Companion 2, Female Companion 3, Female Companion 4, and Female Companion 5; c)
`
`charitable donations; d) payments to Basketball Coach 1 for coaching Individual 1; e) lease
`
`pam ents to the Esformes M anagement Companies; and 9 limousine services for himself and
`
`. others, including Basketball Coach 2.
`
`.
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`
`27. PH ILIP ESFO RM ES, O D ETTE BA R CH A , A R N A T,D O C A R M O UZE,
`
`N ursing H om e A dm inistrator 1, and their co-conspirators falsified, fabricated and altered, and
`
`caused the falsification, fabrication, and alteration of m edical records to support services
`
`purportedly rendered at H ospital 1, the Esfonnes N etwork, and other health care providers
`
`operated by co-conspirators.
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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 15 of 57
`
`28
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`.
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`A R N A LD O CA RM O U ZE signed what he knew to be falsified, fabricated, and
`
`altered prescriptions and medical records, including home health referrals, admissions at Hospital
`
`1, discharge paperwork at Hospital 1, and office visit notes without proper supervision of a
`
`physician and, in m any instances, w ithout ever m eeting w ith the Esform es N etw ork beneticiary.
`
`C AR M O UZE also prescribed m edically unnecessary narcotics, including O xycodone, w ithout a
`
`license, to Esform es N etw ork beneficiaries.
`
`29.
`
`PH ILIP ESFO RM ES, tlzrough A H CA Interm ediary 1, A H CA Interm ediary 2,
`
`'
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`Gabriel D elgado, G uillerm o D elgado, and other co-conspirators, bribed A H CA Em ployee 1 for
`
`non-public schedules providing advance notice of unannounced A H CA inspections and patient
`
`com plaints at the SN FS and A LFS.
`
`'
`30. PH ILIP E SFO R M ES, O D ETTE BA R CH A , A R N AI,D O CA R M O UZE , and
`
`their co-conspirators used these schedules of the unalm ounced inspections and patient com plaints
`
`to evade detection by A H CA of adm inistrative violations which could lead to the term ination of
`
`Esfonnes N etw ork facilities from M edicare and M edicaid.
`
`31. In or arotm d January 2016, PH IL IP ESFO RM ES ptlrchased the psychiatric w ing
`
`of H ospital 2, and used, or attem pted to use, H ospital 2 to cycle M edicare and M edicaid patients
`
`throughout the Esform es N etwork. ESFO R M ES concealed his ow nership interest in H ospital 2
`
`to cM s on M edicare enrollment docum ents.
`
`32. PH ILIP E SFO RM ES, O D ETTE BA R CH A , A R N AI,D O C A RM O U ZE , and
`
`others, through the use of interstate w ires, caused M edicare to m ake paym ents for services that
`
`w ere m edically umw cessary, never provided, and procured through the paym ent of kickbacks and
`
`yyo es.
`
`A 11 in violation of Title 18, U nited States Code, Section 1349.
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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 16 of 57
`
`C O U N TS 2-3
`H eaIth Care Fraud
`(18 U.S.C. j 1347)
`
`1.
`
`Paragraphs 1 through 19 and 22 throug,h 35 of the General Allegations section of
`
`this Third Superseding Indictm ent are re-alleged and incorporated by reference as though fully set
`
`f rth herein.
`o
`
`2.
`
`From in or around January 2009, and continuing through in or around June 2016,
`
`in M iam i-D ade cotmty, in the Southern D istrict of Florida, and elsew here, the defendants,
`
`PH ILIP ESFO R M E S
`dan
`
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`Ay p o c A > o tlzEA R x .
`
`,
`
`in connection w ith the delivery of and paym ent for health care benetks, item s, and services, did
`
`know ingly and w illfully execute, and auem pt to execute, a schem e and artitu e to defraud a health
`
`care benest program affecting com m erce, as defined in Title 18, U nited States Code, Section
`
`24(b), that is, M edicare and M edicaid, and to obtain, by means of materially false and fraudulent
`
`preterises, representations, and prom ises, m oney and property ow ned by, arid tm der the custody
`
`and control of said health care benefit program s.
`
`Purpose of the Schem e and A rtifice
`
`3.
`
`It w as a purpose of tht schem e and artifice for the defendants and their accom plices
`
`to unlawfully enrich themselves by, among other things: (a) creating fake medical documentation .
`
`for services that w ere not rendered, not necessary, or not provided under the proper supervision of
`
`a physician; (b) submitting and causing the submission of false and fraudulent claims to M edicare
`
`and M edicaid; and (c) concealing the submission of false and fraudulent claims to M edicare and
`
`M edicaid.
`
`T he Schem e and A rtince
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`Case 1:16-cr-20549-RNS Document 869 Entered on FLSD Docket 07/19/2018 Page 17 of 57
`
`4.
`
`The allegations contained in paragraphs 4 through 32 of the M anner and M eans
`
`section of Count 1 of this Third Superseding lndictment are re-alleged and incorporated by
`
`reference as though fully set forth herein as a description of the schem e and artifice only as those
`
`allegations relate to A RN ALD O C A RM O U ZE and PH ILIP E SFO R M E S.
`
`A cts in E xecution or A ttem pted Execution of the Schem e and A rtifice
`
`5.
`
`O n or about the dates set forth as to each count below , in M iam i-Dade County, in
`
`the Southern D istrict of Florida and elsew here, the defendants,
`
`pju jwjp s sFo a Es
`and
`Ajtx A ym o CA R M O U ZE
`
`in connection w ith the delivery of and paym ent for health care benetks, item s, and services, did
`
`know ingly and willfully execute, and attem pt to execute, the above-described schem e and artifice
`
`to defraud a health care benefit program affecting com m erce, as defined by Title 18, United States
`
`Code, Section 24(b), that is, Medicare and Medicaid, and to obtain, by means of materially false
`
`and fraudulent pretenses, representàtions, and prom ises, m ùney and property ow ned by, and under
`
`the custody and control of said health care benefit programs, that is, the defendants submitted and
`
`caused the subm ission of false and fraudulent claim s to M edicare, as listed below :
`
`Count Beneficiary Approx.
`N am e
`Claim
`Receipt
`jjajg
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`
`Services
`Claim ed
`
`Approxim ate
`A m ount
`Billed to
`V edjcare
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`Claim Number
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`2
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`3
`
`S.J.
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`9/1/11
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`Office Visit in
`ALF
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`S J
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`9/14/11 OXYCODONE
`H C L
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`$95
`
`598312167120160
`
`$62
`
`30000958375508
`19301930356
`
`ln violation of Title 18, United States Code, Sections 1347 and 2.
`
`17
`
`