Miami-Based Physician Charged for Role in Pain Pill Diversion and Medicare Fraud Scheme
A physician licensed in Puerto Rico, who was practicing medicine in Miami, was charged in a 16-count indictment unsealed today for his alleged participation in a multi-faceted $20 million health care fraud scheme involving the submission of false and fraudulent claims to Medicare and Medicaid and the illegal distribution of oxycodone and other controlled substances.
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 United States Secret Service’s (USSS) Miami Field Office made the announcement.
Roberto A. Fernandez, M.D., 51, of Miami, was charged with one count of conspiracy to commit health care fraud and wire fraud, 11 counts of health care fraud, one count of conspiracy to defraud the United States and pay and receive health care bribes and kickbacks, one count of conspiracy to distribute controlled substances and two counts of distribution of controlled substances. Fernandez was arrested on March 22, 2017, and made his initial appearance today before U.S. Magistrate Judge Andrea M. Simonton of the Southern District of Florida.
According to the indictment, from approximately December 2009 to March 2017, Fernandez owned and operated Florida-based Latin Foundation for Health Inc. and purported to practice medicine as an “area of critical need” doctor at Latin Foundation for Health and other facilities in Miami-Dade County.
The indictment alleges that from approximately January 2011 through February 2017, Fernandez referred Medicare beneficiaries and Medicaid recipients who were purportedly under his care to Calan Pharmacy & Discount Service LLC, a Medicare Part D provider, and several Miami-area home health agencies in exchange for illegal bribes and kickbacks from his co-conspirators. The indictment further alleges that Fernandez submitted false and fraudulent claims through Medicare Part B for services, office visits and procedures that he never provided, such as therapeutic injections and removal of lesions from patients’ faces, and provided prescriptions for home health services and medications regardless of whether they were medically necessary.
The indictment further alleges that Fernandez illegally dispensed controlled substances, including but not limited to the Schedule II controlled substances Oxycodone and Hydrocodone and the Schedule IV controlled substance Alprazolam, to his co-conspirators.
According to the indictment, Fernandez and his co-conspirators caused Medicare to pay at least approximately $4.4 million based on false and fraudulent claims that they caused to be submitted. The indictment also alleges that Medicare, through Part D, paid a total of approximately $20 million as a result of claims submitted listing Fernandez as the prescribing physician.
An indictment is merely an allegation and the defendant is presumed innocent unless and until proven guilty beyond a reasonable doubt in a court of law.
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. Former Fraud Section Trial Attorney and current Assistant U.S. Attorney Lisa H. Miller of the Southern District of Florida and Fraud Section Trial Attorney Adam G. Yoffie are prosecuting the case.
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 3,000 defendants who have collectively billed the Medicare program for more than $11 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.