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Defendant Name, Crime, State Year
Roberto A. Fernandez, a 51-year-old licensed physician based in Miami, pleaded guilty in federal court yesterday for his role in a multi-faceted $4.8 million health care fraud scheme that ran from April 2011 to February 2017.
The scheme involved the submission of false and fraudulent claims to Medicare and the illegal prescribing of Schedule II (e.g., oxycodone and hydrocodone) and Schedule IV (e.g., alprazolam) controlled substances. Fernandez referred Medicare beneficiaries to pharmacy owners in exchange for illegal health care kickbacks, admitting that he knew the pharmacy owners were billing and receiving reimbursements from Medicare for prescription drugs based upon the prescriptions he sold.
For example, Fernandez admitted providing prescriptions for expensive, name brand drugs, including anti-psychotics and HIV/AIDS medications that were not medically necessary. He also solicited referrals of Medicare beneficiaries to his own practices from his co-conspirators, submitting claims to Medicare under his Part B provider number for services he did not, in fact, render to Medicare beneficiaries.
Fernandez admitted receiving kickbacks in return for signing plans of care and prescriptions for home health services. He also prescribed controlled substances, including dangerous opioids, to patients and patient recruiters in return for $100 – $200 cash per prescription, admitting that he knew these patients did not need the controlled substances he prescribed.
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.
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.
Sentencing is set for September 20, with Fernandez facing charges for conspiracy to commit health care fraud and wire fraud. The Medicare Fraud Strike Force has charged nearly 3,000 defendants who have collectively billed the Medicare program for more than $11 billion since its inception in March 2007.
Key Facts
- State: Federal
- Category: Drug Trafficking|Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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