Be Very Alarmed

11742853 - money and pills

Drug addiction statistics in America are alarming. Consider the fact that opioid addiction kills about 100 people across the United States every day. (You should be very alarmed at that shocking statistic.) A physician who was licensed in Puerto Rico, but practiced medicine in Florida, contributed to this epidemic by writing illegal prescriptions for a variety of controlled substances that typically lead to abuse and addiction. He participated, along with other co-conspirators, in a multi-faceted health scheme that illegally collected $4.8 million in Medicare funds.

Over approximately six years, the physician, who owned and operated a Florida-based medical practice, referred Medicare beneficiaries to various pharmacies in exchange for kickbacks from those businesses. (He wrote illegal prescriptions for oxycodone, hydrocodone, alprazolam, other expensive name brand drugs, including anti-psychotics, and HIV/AIDS medications that were not medically necessary.)

The Miami-area doctor also solicited Medicare beneficiary referrals to his own practices from his co-conspirators. (Talk about “I’ll scratch your back if you scratch mine.”) The deceptive doc used these referrals to submit claims to Medicare under his Part B provider number for services he did not provide. (Apparently, he billed for unnecessary therapeutic injections and facial lesion removals.) And that’s not all he did. He also received kickbacks for signing care plans for home health services that were not needed. (This guy was quite the fraud entrepreneur. He had lots of fraudulent schemes running all at the same time.)

The 51-year-old physician admitted that he knew the pharmacy owners, who he was in collusion with, were billing and receiving Medicare reimbursements because of the prescriptions he had sold them, even though he knew the patients did not need the medication. (He made between $100 and $200 in cash for each prescription.) He also confessed to not examining the patients for whom he wrote the prescriptions. The 51-year-old Floridian pleaded guilty to one count of conspiracy to commit healthcare fraud and wire fraud. His sentencing is set for the fall.

Congratulations to the Medicare Strike Force who was instrumental in the capture and prosecution of this criminal for Medicare fraud. The investigative organization, which operates in nine states across the nation, has charged nearly 3,000 defendants who have collectively charged the federal Medicare program more than $11 billion.

Today’s “Fraud of the Day” is based on an article entitled, Miami Doc Pleads Guilty to Writing Illegal Prescriptionpublished by the Miami Patch.

MIAMI, FL — A Miami doctor has pleaded guilty to Medicare fraud and illegally writing prescriptions for oxycodone, hydrocodone and alprazolam. Fifty-one year-old Roberto A. Fernandez, pleaded guilty to one count of conspiracy to commit health care fraud and wire fraud. He faces a Sept. 20. sentencing date.

Appearing before U.S. District Judge Cecelia M. Altonaga on Tuesday, Fernandez admitted his role in connection with what prosecutors described as a “multi-faceted” $4.8 million health care fraud scheme.





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Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.