Federal prosecutors will be able to retry Philip Esformes on six healthcare fraud charges after the US Supreme Court declined to hear an appeal on Monday from the former assisted living community and nursing home owner.
This is the second time this year that the high court denied appeals from Esformes. In April, Justice Clarence Thomas rejected an emergency appeal seeking to stay a decision from the 11th US Circuit Court of Appeals affirming his 2019 conviction on 20 charges. Esformes’ attorneys had argued that the case should be thrown out after the government improperly seized and used documents protected by attorney-client privilege.
Esformes had been convicted on charges including conspiracy to defraud the United States, money laundering, paying and receiving kickbacks, bribery, wire fraud and obstruction of justice. The federal government had called the $1.3 billion healthcare fraud case “the largest healthcare fraud scheme charged by the US Justice Department.” The jury, however, did not reach a verdict on six counts, which prosecutors said they intended to pursue.
Former President Donald Trump comminuted Esformes’ 20-year prison sentence in December 2020 but left intact the remaining parts of his sentence, including three years of supervised release, the payment of $5.5 million in restitution and the forfeiture of $38.7 million equivalent to property traced back to Esformes’ money laundering offenses.
Reality TV personality Kim Kardashian shined the spotlight on Esformes’ case last spring in a series of tweets a few days after federal prosecutors received the green light to retry Esformes on pending healthcare fraud charges.
A case history
Esformes first was charged in 2016. The federal government, in part, alleged that he would move skilled nursing residents to his assisted living facilities when they were at or near the end of Medicare’s 100-day post-hospital benefit period for skilled nursing. “After the required 60-day waiting period between consecutive admissions to an [sic] SNF, a physician or physician assistant would readmit the beneficiary to the hospital, re-initiating the cycle,” according to a federal motion in 2016.
Meanwhile, the government alleged, Esformes provided access to assisted living residents “for any healthcare provider willing to pay a kickback” — including pharmacies, home health agencies, physician groups, therapy companies, partial hospitalization programs, laboratories and diagnostic companies — even though many of the services for which they were paid were not medically necessary or were never provided.
