Record Medicare fraud case targets Keys homeowner

July 30--A Miami medical professional charged as a primary defendant in a massive Medicare fraud investigation apparently owns a Big Pine Key house.

Arnaldo Carmouze, 56, a physician's assistant, was charged along with Philip Esformes, 47, and Odette Barcha, 49, in what U.S. Assistant U.S. Attorney General Leslie R. Caldwell called "the largest single criminal health-care fraud case ever brought against individuals by the Department of Justice."

"Philip Esformes, Arnaldo Carmouze and others, through the use of interstate wires, submitted and caused the submission of false and fraudulent claims to Medicare and Medicaid in an approximate amount of $1 billion for services that were medically unnecessary, never provided, and procured through the payment of kickbacks and bribes," says a federal indictment filed July 21.

Carmouze lists his address and workplace as 6545 SW 95th Ave. in Miami. That is the same address where Monroe County sends Carmouze a property-tax bill for his single-family home at 29037 Violet Drive in Big Pine'sEden Pines Colony subdivision. The canalfront elevated home, with two bedrooms and one bath, has a market value of $241,156, the Monroe County Property Appraiser's Office says.

In 2007, the home was listed with a worth of $415,079 for tax purposes. Its last listed sale price was $600,000 in 2005, according to real-estate website Zillow.com.

"The magnitude of alleged false claims in this scheme is staggering and outrageous, even by South Florida health-care fraud standards," U.S. Attorney Wifredo Ferrer said in a July 22 press conference. "This case illustrates once again that Medicare fraud has infected every aspect of the health-care system."

The indictment says Esformes, Carmouze "and others ... caused Medicare to pay approximately $464 million for services that were medically unnecessary, never provided, and procured through the payment of kickbacks and bribes." They also are accused of taking kickbacks to refer patients to other shady facilities that submitted their own bills to Medicare.

Carmouze was released from federal custody Wednesday pending trial. If convicted on all nine fraud and money-laundering counts, the maximum sentence could reach 100 years. A call placed to a telephone number listed for Carmouze was answered by a voicemail for an information-technology company.

Esformes in 2006 paid a penalty of $15.4 million "to resolve civil federal health-care fraud claims for essentially identical conduct, namely unnecessarily admitting patients from his assisted-living facilities into a Miami-area hospital," the U.S. Attorney's Office says.

Esformes is accused of using proceeds from the alleged scheme to live lavishly, procure escorts and send a relative to basketball camps run by a renowned coach.

The Miami Herald reported that Esformes' defense attorneys issued a statement saying: "Mr. Esformes is a respected and well-regarded businessman. He is devoted to his family and his religion... Mr. Esformes adamantly denies these allegations and will fight hard to clear his name."

With reports from the Miami Herald

Kevin Wadlow: 305-440-3206

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