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Bribes to Low-Paid State Worker Key to $1 Billion Miami Medicare Fraud Case, Prosecutors Say

The Miami Herald


By Jay Weaver

Philip Esformes is 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. He also owns two homes next door to each other on exclusive North Bay Road in Miami Beach, along with numerous other properties in Miami, Chicago and Los Angeles.

Bertha Blanco, a former state administrator who lives in working-class Hialeah, made $31,281 a year overseeing inspections of the very same kinds of healthcare facilities in Miami-Dade. She was fired in late 2016 after working for 29 years at the Florida Agency for Health Care Administration.

Esformes, 48, and Blanco, 66, lived worlds apart but federal authorities say they were linked in a long-running $1 billion Medicare ripoff.

Esformes, charged last year in what has been touted as the nation’s biggest Medicare fraud case, supplied tens of thousands of dollars in cash to Blanco but never knew her. Prosecutors say the bribes were passed through four other people who have already pleaded guilty.

Blanco, according to a new criminal case filed against her, was a small cog in the complicated operation, supplying confidential information on patient complaints and unannounced state inspections at Esformes’ facilities.

That inside information helped keep the Medicare tap flowing, according to court records. Esformes would use the information sold by Blanco — the first state AHCA employee ever to be charged with accepting bribes — to “address deficiencies” before state inspectors showed up at his facilities, a Health and Human Services criminal affidavit says. As a result, Esformes avoided the revocation of his licenses and continued to bill Medicare for questionable patient services.

Esformes relied on two trusted business associates — brothers Gabriel and Guillermo Delgado — to obtain the valuable state information, by paying $200 cash for each patient complaint and $3,000 cash for each unannounced inspection schedule over the span of five years. Gabriel Delgado then “personally provided these documents to Philip Esformes,” according to the criminal affidavit.

Two people acted as intermediaries for the Delgados: Isabel Lopez, who also owned several assisted-living facilities, and her son, Gustavo Mustelier. They kept a cut of the cash bribes while delivering the rest to Blanco to obtain patient and inspection records. According to statements filed with their plea deals, they delivered payoffs to the state administrator for the confidential information on two Miami-Dade facilities owned by Esformes: The Nursing Center at Mercy and Fair Havens Center.

Lopez and her son admitted they paid off Blanco for inside information on Lopez’s assisted-living facilities and on those belonging to at least five ALF owners, including Esformes.

At her end, Blanco either provided the confidential documents or called and texted the sensitive information, according to the criminal affidavit. She sometimes made the exchanges at a McDonald’s in Doral, or enlisted her son to make the deliveries.

Blanco’s defense attorney, Robyn Blake, said she is reviewing the Justice Department’s evidence against her client before deciding whether to go to trial or strike a plea deal. Blanco, who was arrested earlier this month and released from custody on a $250,000 bond, is scheduled for arraignment in Miami federal court on Sept. 1

“We don’t know which direction the case is headed right now,” Blake said.