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Gaming the System

Published on April 17th, 2010

Chicago Tribune ran an article about the federal investigation into another corrupt business scheme involving nursing home operators.  Dr. Roland Borrasi told co-workers he made cash payoffs to prominent nursing home operators in exchange for access to a lucrative pool of patients.  Federal prosecutors, who last year secured the conviction of Borrasi for taking more than $500,000 in kickbacks from Rock Creek, did not specify which nursing home operators Borrasi allegedly paid.  The article centers around the greedy Esformeses and their relationship to Borrasi.  The Esformeses were part of a group of "businessmen" that previously paid the U.S. Justice Department $15.4 million to settle civil claims of kickbacks and health care fraud stemming from a Florida patient-brokering case. They deny wrongdoing though. 

Lynn Madeja, Borrasi’s medical biller and mistress, told government agents that Borrasi had said: "I got to give Philip [Esformes] $1,000 or $10,000." To use Esformes’ patients, Borrasi told her, he "had to make it up" with cash, said Madeja, who assisted authorities in their investigation. Borrasi said "it was Esformes’ way or no way," Madeja’s statement said.

In addition, the medical director of Rock Creek Center psychiatric hospital, Dr. Naseem Chaudhry, told federal agents about a conversation in which Borrasi allegedly said he was upset because Rock Creek owed him $200,000. "He was concerned because he needed to give half of it to Esformes," Chaudhry said. Chaudhry pleaded guilty Wednesday to a count of health care fraud.

Abhin Singla, a member of Borrasi’s medical group, told investigators "Esformes controls the flow of patients in and out of his nursing homes to ensure that he is receiving the maximum allowed benefit."   Singla was with Borrasi when Esformes called and told Borrasi to admit at least five nursing home patients to various hospitals. Borrasi quickly did so without asking about their conditions.  Borrasi told Singla "someone would find something wrong with the patients to justify the admissions," Singla said.   Singla stepped forward to help because he was appalled by the "fraudulent use of public health care dollars and compromise to patient care."

Esformes, who operates nursing homes Florida as well as Illinois, denies invovlement but his attorney attacked everyone’s credibility.   One of Esformes’ numerous defense attorneys, Michael Pasano argued that "Borrasi stands convicted," and the co-workers who quote him had no direct knowledge of any a lleged payments and are biased and "lack credibility,".

But former Rock Creek discharge planner and social worker Kimberly Reevas, who helped authorities unravel the scheme, told agents Philip Esformes was often at the hospital and was deeply involved with hospital staff in steering patients to his facilities.

At one meeting, Reevas said, Esformes explained to Rock Creek social workers the type of patients they should send to each of his nursing homes. According to Reevas, "Esformes further instructed the social workers to only send patients with public aid, public aid pending, disability, or Medicare."

 Clearly they were gaming the system and were more concerned by maximum profit and greed then the care provided by the overworked and underappreciated staff.
 

Joe Pioletti
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