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Roberto A. Fernandez, M.D. of Miami Pleads Guilty for Role in Pain Pill Diversion and Medicare Fraud Scheme

July 13, 2017

Investigating this pain pill scheme likely cost the federal health care system hundreds of thousands of dollars and a years-long period of time. Even more damaging is Roberto A. Fernandez’ name won’t appear on a published exclusion list until well after his sentencing which will take place in September of 2017. Searching FACIS reveals fraudulent behavior dating back to 2015.

When a search is conducted on Verisys’ FACIS searchable database, several records come up that would indicate the character and the risk associated with this individual. For instance, FACIS has a record dated November of 2015 stating that Roberto Fernandez, age 49, falsely billed Medicaid for procedures never performed. Then in 2016, there is a notice of a default and dismissal, and in March of this year, FACIS published that he was charged for his role in Pain Pill Diversion and Medicare Fraud Schemes. Licensed in Puerto Rico and practicing in Miami, he is part of a scheme defrauding the Federal Government out of $20 million designed to put oxycodone and other controlled substances on the streets illegally.

Is this a physician you may have referred? Or hired?

If all you had access to was NPDB and the OIG’s LEIE, you would have no reason not to hire or refer this physician—or hire as a Locum Tenens. With FACIS, you see the whole picture with one simple search.

When conducting exclusion screening and exclusion monitoring, only looking for current exclusions allows for fraud to continue until due process of an investigation, allegations, a plea, a trial and conviction are concluded and an exclusion is issued. This is a multi-year process putting an entire industry of legitimate institutions and innocent patients at risk.

One search with FACIS creates the gatekeeping mechanism to keep bad actors like Roberto Fernandez out of the system and provides the transparency needed to stop fraudsters sooner—Maybe $19 million sooner. And hundreds fewer over-dose fatalities.

Here is the story:

A licensed physician in Miami pleaded guilty in federal court yesterday for his role in a multi-faceted $4.8 million health care fraud scheme that ran from April 2011 to February 2017, involving the submission of false and fraudulent claims to Medicare and the illegal prescribing of Schedule II (e.g., oxycodone and hydrocodone) and Schedule IV (e.g., alprazolam) controlled substances (pain pill)s.

Acting Assistant Attorney General Kenneth A. Blanco of the Justice Department’s Criminal Division, Acting U.S. Attorney Benjamin G. Greenberg of the Southern District of Florida, Special Agent in Charge George L. Piro of the FBI’s Miami Field Office, Special Agent in Charge Shimon R. Richmond of the U.S. Department of Health and Human Services Office of Inspector General’s (HHS-OIG) Miami Regional Office, and Special Agent in Charge Brian Swain of the U.S. Secret Service’s (USSS) Miami Field Office made the announcement.

Roberto A. Fernandez, M.D., 51, of Miami, pleaded guilty before U.S. District Judge Cecelia M. Altonaga of the Southern District of Florida to one count of conspiracy to commit health care fraud and wire fraud related to pain pill diversion. Sentencing is set for September 20.

According to admissions made as part of his guilty plea, Fernandez referred Medicare beneficiaries to pharmacy owners in exchange for illegal health care kickbacks. Fernandez admitted knowing that the pharmacy owners were billing and receiving reimbursements from Medicare for prescription drugs based upon the prescriptions he sold, and that his patients did not truly need many of the medications he prescribed in exchange for the kickbacks. For example, he admitted providing prescriptions for expensive, name brand drugs, including anti-psychotics and HIV/AIDS medications that were not medically necessary.

Fernandez also solicited referrals of Medicare beneficiaries to his own practices from his co-conspirators, he admitted, including submitting claims to Medicare under his Part B provider number for services he did not, in fact, render to Medicare beneficiaries. Additionally, Fernandez admitted receiving kickbacks in return for signing plans of care and prescriptions for home health services.

Fernandez also admitted that he prescribed controlled substances, including dangerous opioids, to patients and patient recruiters in return for $100 – $200 cash per prescription. Fernandez admitted that he knew these patients did not need the controlled substances he prescribed. Furthermore, Fernandez admitted that he wrote many of these controlled substance prescriptions for patients that he did not even examine.

The FBI, HHS-OIG, and USSS investigated the case, which was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida. Former Fraud Section Trial Attorney and current Assistant U.S. Attorney Lisa H. Miller of the Southern District of Florida and Fraud Section Trial Attorney Adam G. Yoffie are prosecuting the case.

The Fraud Section leads the Medicare Fraud Strike Force. Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 3,000 defendants who have collectively billed the Medicare program for more than $11 billion. In addition, the HHS Centers for Medicare & Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers.

Susen SawatzkiWritten by Susen Sawatzki
Healthcare Industry Expert
Muse. Writer. Publisher. Producer. Creator of Inspiring Narratives.
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