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Florida Doctor Gets 8 Years in Prison for Medicare Fraud

The plan seemed so simple: refer patients to friendly pharmacies to fill prescriptions they don't need, then get a nice little kickback from pharmacy owners. Maybe throw some extra pain pill prescriptions to patients without ever seeing them, and bill Medicare for some never-performed medical services. Easy money, right?

Well easy come, easy go, as they say, and now Dr. Roberto A. Fernandez will be paying $4.8 million in restitution and serving 97 months in prison after pleading guilty to one count of conspiracy to commit health care fraud and wire fraud.

Medicare Kickbacks

Fernandez was originally facing that one count of conspiracy to commit healthcare fraud and wire fraud, along with:

  • 11 counts of healthcare fraud;
  • 1 count of conspiracy to defraud the United States and pay and receive healthcare bribes and kickbacks;
  • 1 count of conspiracy to distribute controlled substances; and
  • 2 counts of distribution of controlled substances.

According to federal law enforcement, for the past six years the Miami-based doctor was submitting false and fraudulent claims to Medicare and the illegally prescribing controlled substances, including oxycodone, hydrocodone, and alprazolam.

One Bad Apple

And if all of that sounds pretty vague, the Department of Justice has some more disturbing details. Fernandez allegedly admitted that many of his prescriptions were medically unnecessary, including providing "prescriptions for expensive, name brand drugs, including HIV/AIDS medications that conflicted with other HIV drugs already prescribed to the beneficiaries." He also received kickbacks in return for "signing plans of care and prescriptions for medically unnecessary home health services," and wrote prescriptions for controlled substances for patients he never met.

And Fernandez wasn't alone. The fraud and pill scheme covered at least six healthcare facilities, and amassed over $20 million in fraudulent expenses. And some of his co-conspirators are already incarcerated: Niurka Fernandez for 10 years; Arturo Alberto Oms for eight years; Jesus Diaz for nine years; and Jorge Caballero for three years and four months.

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