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, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.