Medicare illustrationA Miami Beach health care executive was sentenced Thursday to 20 years in prison for orchestrating what federal prosecutors described as a massive $1 billion Medicare fraud scheme.

U.S. District Judge Robert Scola in Miami imposed the sentence on Philip Esformes, 50, in one of the biggest such cases in U.S. history.

Scola called the case one of a violation of trust of "epic proportions" and said Esformes was "somewhat of an enigma" because of his obvious success combined with such a large criminal operation.