Miami Physician Gets 8 Years for 'Multifaceted' Fraud

September 25, 2017

A physician in Miami, Florida, was sentenced by a federal judge last week to 97 months in prison in a textbook case of how many ways to defraud Medicare.

And there's some paying back to do — $4.8 million worth.

Roberto Fernandez, MD, pleaded guilty in July to one count of conspiring to commit healthcare and wire fraud. That single criminal count encompasses a "multifaceted…scheme" that ran from April 2011 to February 2017, prosecutors said. The 51-year-old Dr Fernandez admitted that he:

  • Received kickbacks from a pharmacy in exchange for referring patients there to fill prescriptions he wrote. Some scripts were for expensive antipsychotics and cancer and HIV/AIDS drugs, even though patients weren't necessarily diagnosed with these conditions, prosecutors said.

  • Ordered unnecessary home healthcare services and signed plans of care in exchange for kickbacks.

  • Prescribed medically unnecessary oxycodone, hydrocodone, and alprazolam to patients, some of whom he never examined, for $100 to $200 in cash per prescription. Prosecutors said his waiting room would fill up with 30 drug-seekers, indicative of a pill mill.

Prosecutors point to other healthcare scams on his part, such as submitting claims for services supposedly rendered while he was out of the country and procedures performed on at least two patients after their death dates.

"Effectively [the] defendant sold his license and abdicated his professional responsibilities, all for money," prosecutors said in a court filing.

Dr Fernandez and his coconspirators are "jointly and severally" on the hook for $4.8 million in restitution to Medicare, meaning that the government can try to collect the full amount from any one defendant. If Dr Fernandez works inside a federal prison, 50% of his earnings must go toward the $4.8 million. If he isn't employed, he must pay at least $50 every 3 months.

Follow Robert Lowes on Twitter @LowesRobert

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