Miami Physician Sentenced to 97 Months for Role in Pain Pill Diversion and $4.8 Million Medicare Fraud Scheme
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.