Good question… how can one guy do that much?
Part of how he got away with it was bribing others to participate so it wasn’t just one guy doing this it was really a network of illegal conspirators.
Different reports say he ran 20 or 30 nursing homes and assisted living facilities.
They say the fraud goes back 18 years.
Also one report said :
“Prosecutors said his healthcare network as well as other co-conspirators billed $1 billion for fraudulent medical services since 2009. In turn, Medicare paid Esformes’ skilled-nursing and assisted-living facilities and the Delgado brothers’ healthcare operations about $500 million.”
Its unclear how they get to $1.3B. Was that $1.3B he over charged people? Or $1.3B that was fraudulently paid? Above says he billed $1B and Medicare paid $500M. So maybe its only $500M? Or maybe its $500M from Medicare and $800M from other insurance and out of pocket?
But either way spreading $1B was spread across 18 years in 20-30 facilities with maybe 200 beds per facility. So we’re in the ballpark of $10k per resident treated in fraud. Or if it was really just $1B billed and $500M paid then half that.
They also said some of the fraud was unnecessary procedures and unnecessary care. They would admit patients who didn’t really need nursing home care and charge for it. Nursing home care can be 1000’s a month so if maybe 10% of the residents didn’t really need to be there across 20+ facilities then that would add up to lots of unnecessary charges very quickly.
It also says the guy in question profited $37 M from all the fraud. Thats only 3-4% of the total alleged number. I’d imagine then that most of the fraud was unnecessary care that he profited from rather than outright false charges.
I’d imagine that its easier to get away with unnecessary care than outright bogus claims. If auditors investigate then theres a patient and records of care and the argument is against a doctor who claims the care was necessary. But the doctor was bribed and complicit in the fraud.