A Miami physician was sentenced today to 97 months in prison
and three years of supervised release, for his role in a $4.8 million health
care fraud scheme that involved the submission of false and fraudulent claims
to Medicare and the illegal prescribing of controlled substances, including
oxycodone and hydrocodone.
Acting Assistant Attorney General Kenneth A. Blanco of the
Justice Department’s Criminal Division, Acting U.S. Attorney Benjamin G.
Greenberg of the Southern District of Florida, Special Agent in Charge George
L. Piro of the FBI’s Miami Field Office, Special Agent in Charge Shimon R.
Richmond of the U.S. Department of Health and Human Services Office of
Inspector General’s (HHS-OIG) Miami Regional Office and Special Agent in Charge
Brian Swain of the U.S. Secret Service’s (USSS) Miami Field Office made the
announcement.
Roberto A. Fernandez, M.D., 51, of Miami, was sentenced by
U.S. District Judge Cecelia M. Altonaga of the Southern District of
Florida. Judge Altonaga also ordered
Fernandez to pay $4.8 million in restitution, jointly and severally with his
co-conspirators. Fernandez pleaded
guilty on July 11, to one count of
conspiracy to commit health care fraud and wire fraud in connection with a
scheme, that ran from April 2011 to February 2017, involving the submission of
false and fraudulent claims to Medicare and the illegal prescribing of
controlled substances, including oxycodone, hydrocodone and alprazolam.
As part of his guilty plea, Fernandez admitted that he
referred Medicare beneficiaries to pharmacy owners in exchange for illegal
health care kickbacks. Fernandez
admitted knowing that the pharmacy 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, he admitted
providing prescriptions for expensive, name brand drugs, including HIV/AIDS
medications that conflicted with other HIV drugs already prescribed to the
beneficiaries.
Fernandez also solicited referrals of Medicare beneficiaries
to his own 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. Additionally,
Fernandez admitted to receiving kickbacks in return for signing plans of care
and prescriptions for medically unnecessary home health services.
Fernandez further admitted that he prescribed controlled
substances, including addictive opioids, to patients and patient recruiters in
return for $100 to $200 cash per prescription.
Fernandez admitted that he knew these patients did not need the
controlled substances he prescribed, and that he would sometimes write
prescriptions for controlled substances for patients whom he did not even
examine.
The FBI, HHS-OIG and USSS investigated the case, which was
brought as part of the Medicare Fraud Strike Force, supervised by the Criminal
Division’s Fraud Section and the U.S. Attorney’s Office for the Southern
District of Florida. Assistant U.S.
Attorney Lisa H. Miller of the Southern District of Florida and a former Fraud
Section trial attorney, and Fraud Section Trial Attorney Adam G. Yoffie are
prosecuting the case.
The Fraud Section leads the Medicare Fraud Strike Force,
which is part of a joint initiative between the Department of Justice and HHS
to focus their efforts to prevent and deter fraud and enforce current
anti-fraud laws around the country. The
Medicare Fraud Strike Force operates in nine locations nationwide. Since its inception in March 2007, the
Medicare Fraud Strike Force has charged over 3,500 defendants who collectively
have falsely billed the Medicare program for over $12.5 billion.
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