Mother and Son Plead Guilty to Orchestrating $16 Million Medicare Fraud Scheme at Two Miami Pharmacies
A mother and son based in Miami each pleaded guilty today to fraud charges for their roles in a $16 million Medicare fraud scheme.
Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office and 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 made the announcement.
Niurka Fernandez, 54, and Roberto Alvarez, 29, both of Miami, each pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Federico A. Moreno of the Southern District of Florida. The sentencings have been scheduled for Nov. 8, 2016, before Judge Moreno.
As part of her guilty plea, Fernandez admitted that she was an owner of Calan Pharmacy & Discount Service LLC (Calan Pharmacy) and Bertyann Corp., doing business as Best Pharmacy, two pharmacies located in Miami-Dade County, Florida. Fernandez was an organizer and leader of a Medicare fraud scheme that paid Medicare beneficiaries and patient recruiters for prescriptions that were medically unnecessary, according to the plea agreement. Fernandez also admitted that she and her co-conspirators at Calan Pharmacy and Best Pharmacy billed Medicare for many prescription medications that they never even dispensed to the beneficiaries.
In connection with his guilty plea, Alvarez admitted that he was involved in the Medicare fraud scheme at Best Pharmacy. Alvarez purported to work at Best Pharmacy as a pharmacy technician, but in fact facilitated kickback payments to Medicare beneficiaries, according to the plea agreement. While at Best Pharmacy, Alvarez wrote checks to money launderers in order to obtain cash to pay the kickbacks to the Medicare beneficiaries, he admitted.
Medicare made more than $16 million in overpayments to Calan Pharmacy and Best Pharmacy as a result of the health care fraud scheme, according to admissions made in connection with today’s pleas.
The FBI and HHS-OIG investigated the case, which was brought as part of the Medicare Fraud Strike Force under the supervision of the Criminal Division’s Fraud Section and U.S. Attorney’s Office of the Southern District of Florida. Fraud Section Trial Attorneys L. Rush Atkinson and Lisa H. Miller 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 2,900 defendants who have collectively billed the Medicare program for more than $10 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.