Physician Sentenced to Prison for Role in $4.8 Million Medicare Fraud Scheme.
The Department of Justice (DOJ) recently reported that a Miami, Florida physician was sentenced to 97 months in prison for his participation in a Medicare fraud scheme. The 97 months term will be followed by three years of supervised release. In July 2017, Roberto Fernandez pleaded guilty to conspiracy to commit health care fraud and wire fraud in connection with a scheme. The fraud scheme ran from April 2011 to February 2017. Court testimony and case history indicated that Fernandez and the pharmacy owners submitted approximately $4.8 million in false claims to Medicare for illegal prescriptions. The DOJ Criminal Division’s Fraud Section supervised the case that was brought by the Medicare Fraud Strike Force. The Fraud Section leads the Medicare Fraud Strike Force (MFSF), which is a partnership between the U.S. Attorney’s Offices, the Federal Bureau of Investigation (FBI) and the Department of Health and Human Services (HHS) Office of Inspector General (OIG). The United States Secret Service (USSS) was also involved in the investigation.
Fernandez’s guilty plea demonstrated the following:
- Fernandez referred Medicare beneficiaries to pharmacy owners in exchange for illegal kickbacks;
- Fernandez knew that the prescriptions he sold were medically unnecessary;
- Fernandez knew that pharmacy owners were billing and receiving reimbursements from Medicare based on the sold prescriptions;
- Fernandez solicited referrals to his own practices from his co-conspirators; and
- Fernandez prescribed controlled substances, such as oxycodone and hydrocodone, in exchange for cash, often without examination.
Fernandez was sentenced in the United States District Court of the Southern District of Florida.
The DOJ Justice News article is available at: