Late last month, another major health insurance fraudster was caught in our otherwise wonderful state of Florida. As reported by The Associated Press, courtesy of WLRN.org, 66 year-old, Bertha Blanco has been charged for her role in a scheme to defraud Medicare and Medicaid.

This case, however, is no ordinary health care fraud case. According to the report, Blanco is accused of taking part in what federal authorities are calling “the nation’s biggest health fraud case”. The fraudulent activity involved bilking the nation’s health insurance programs of upwards of $1 billion! The extraordinary nature of this story doesn’t even end there. Blanco is no ordinary fraudster. She just so happens to be a former Florida health care administrator.

Blanco, in fact, had a 29-year career with the Florida Agency for Health Care Administration. She now holds the distinction of being its first-ever employee to be charged with taking bribes. However, she is described by Jay Weaver of The Miami Herald as a “small cog” in a complicated operation.

Weaver reveals that Blanco made approximately $31,281 a year overseeing inspections at nursing facilities owned by Philip Esformes. Described by Weaver as a “fabulously rich businessman who once made more than $10 million in a single year from his network of Miami-Dade nursing and assisted living facilities”, Esformes also owns homes Chicago and Los Angeles.

Blanco benefited from Esformes’ riches by receiving tens of thousands of dollars in cash in exchange for tipping him off about violations in his nursing homes. By receiving this inside information, Esformes was able to address the violations prior to state inspections. This helped him to keep his license active so that he could continue to bill the federal government for “questionable patient services”, says The Associated Press.

Blanco is currently out of custody on a $250,000 bond while Esformes is being held in federal detention, awaiting trial set for March. He is accused of using his 20 nursing facilities to file false Medicare and Medicaid claims for services that were not necessary for 14,000 patients, the report reveals. His lawyers are claiming that the intermediaries to whom Blanco passed along the confidential information acted without his knowledge.

“Two of those intermediaries, brothers Gabriel and Guillermo Delgado, have made plea deals and are expected to testify against Esformes,” informs The Associated Press, “The brothers helped investigators get to Esformes by videotaping a cash transaction that prosecutors said was meant to go for bribes.”

Esformes’ legal team, led by defense attorney, Michael Pasano, adds Weaver, “asserts the Delgado brothers, who have already struck plea deals on Medicare fraud offenses, acted on their own and that Esformes knew nothing about their bribery activity…With the Delgados likely to be critical witnesses for the Justice Department, Esformes’ defense team has been aggressively waging a pre-trial battle to disqualify the team of prosecutors who charged the multimillionaire.”

At Allegiant Experts, we offer clinical expert services to lawyers who try cases against perpetrators of health care fraud. If you could use our help, please don’t hesitate to call us at 407-217-5831 or email us at info@allegiantexperts.com.