A Miami physician will serve eight years and pay millions in restitution for his role in a nearly $5 million health care fraud scheme involving fraudulent Medicare claims and illegal prescriptions for controlled substances including oxycodone and hydrocodone, the Department of Justice announced.
Roberto A. Fernandez, 51, of Miami, was ordered to pay $4.8 million in restitution in an addition to the prison term, and upon release, will have an additional three years of supervised release. He pleaded guilty in July to one count of conspiracy to commit health care fraud and wire fraud in connection with a scheme.
The scheme ran from April 2011 to February 2017. Fernandez confirmed he referred Medicare beneficiaries to co-conspiring pharmacy owners in exchange for illegal kickbacks. He also admitted knowing the pharmacy owners were billing and receiving reimbursements from Medicare for prescription drugs based upon the prescriptions he sold; many of those prescriptions were not medically necessary, according to the DOJ.
"For example, he admitted providing prescriptions for expensive, name-brand drugs, including HIV/AIDS medications that conflicted with other HIV drugs already prescribed to the beneficiaries," the DOJ said.
Fernandez also sought Medicare beneficiary referrals from his co-conspirators for his practices and submitted Medicare claims for services he never actually performed. He admitted receiving kickbacks for signing plans of care and prescriptions for home health services that were not needed and prescribed controlled substances to patients and patient recruiters for $100 to $200 each.
"Fernandez admitted that he knew these patients did not need the controlled substances he prescribed and that he would sometimes write prescriptions for controlled substances for patients whom he did not even examine," the DOJ said.