Miami Physician gets 8 years for $4.8M Medicare fraud

A Miami physician was sentenced to 8 years in prison and 3 years of supervised release, for his role in a $4.8 million health care fraud

A Miami Physician was sentenced to 8 years in prison and 3 years of supervised release, for his role in a $4.8 million health care fraud that involved the submission of false and fraudulent claims to Medicare programme and the illegal prescribing of controlled substances, including hydrocodone and oxycodone.

According to U.S. Attorney’s Office, Roberto A. Fernandez, M.D., 51, of Miami, was sentenced by U.S. District Judge of the Southern District of Florida. The federal judge also ordered Fernandez to pay $4.8 million in restitution, jointly and severally with his co-conspirators.

Dr. Fernandez pleaded guilty on July 12, 2017, to one count of conspiracy to commit health care fraud and wire fraud in connection with a scheme. The scheme he operated from April 2011 to February 2017, comprising the submission of false and fraudulent claims to Medicare and the illegal prescribing of controlled substances, including hydrocodone, oxycodone, and alprazolam.

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As part of the guilty plea, Fernandez admitted that he referred Medicare beneficiaries to pharmacy owners in exchange for illegal health care kickbacks. He admitted knowing that the pharmacy store owners were billing and receiving reimbursements from Medicare for prescription drugs based upon the prescriptions he sold and that many of his prescriptions were medically unnecessary. For example, Fernandez admitted providing prescriptions for expensive, name-brand drugs, including HIV/AIDS medications that conflicted with other HIV drugs already prescribed to the beneficiaries.

The Miami Physician Fernandez also solicited referrals of Medicare beneficiaries to his practices from his co-conspirators, he admitted, including submitting claims to Medicare under his Part B provider number for services he did not, in fact, render. Also, he admitted to receiving kickbacks in return for signing plans of care and prescriptions for medically unnecessary home health services.

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Dr. Fernandez further admitted that he prescribed controlled substances, including addictive opioids, to patients and patient recruiters in exchange for $100 to $200 cash per prescription. Miami Physician admitted that he knew these patients did not need the controlled substances prescribed and that he would sometimes write prescriptions for controlled substances for some patients whom he did not even examine.

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The Fraud Section leads the Medicare Fraud Strike Force, which is part of a joint initiative between HHS and the Department of Justice to focus their efforts to prevent and deter fraud and enforce current anti-fraud laws around the United States. The Medicare Fraud Strike Force operates in nine locations across the country. Since its inception in March 2007, the Medicare Fraud Strike Force has charged more than 3,500 defendants who collectively have falsely billed the Medicare for over $12.5 billion.