customer handing over prescription to pharmacist

Doctor to Serve Time for Medicare Fraud

A Miami doctor was sentenced to over eight years in prison and three years of supervised release for his role in a multimillion-dollar Medicare fraud scheme involving the submission of false and fraudulent claims to Medicare and the illegal prescribing of opioids.

U.S. District Judge Cecelia M. Altonaga of the Southern District of Florida sentenced Dr. Roberto A. Fernandez to 97 months behind bars and ordered him to pay $4.8 million in restitution, jointly and severally with his co-conspirators. The 51-year-old Miami doctor pleaded guilty earlier this summer to one count of conspiracy to commit health care fraud and wire fraud in connection with the Medicare fraud scheme, which ran for nearly six years.

According to the Justice Department, Fernandez’s scheme involved the submission of false and fraudulent claims to Medicare and the illegal prescribing of controlled substances, including oxycodone, hydrocodone, and alprazolam. In his guilty plea, Fernandez admitted to accepting illegal kickbacks in return for referring Medicare beneficiaries to pharmacy owners and for signing plans of care and prescriptions for medically unnecessary home health services. He also admitted to soliciting referrals of Medicare beneficiaries to his own practices from his co-conspirators.

Fernandez told investigators that he knew the pharmacies he conspired with sought reimbursements from Medicare based on the prescriptions he wrote and that many of his prescriptions were medically unnecessary. As an example cited by the Justice Department, Fernandez admittedly wrote prescriptions for expensive, name-brand medications, including HIV/AIDS drugs that conflicted with other HIV drugs already prescribed to patients in his care. He also admitted to submitting claims to Medicare under his Part B provider number for services he did not render.

Additionally, Fernandez admitted that he prescribed controlled substances, including addictive opioids, to patients and patient recruiters in exchange for $100 to $200 cash per prescription. According to investigators, Fernandez knew these patients were not in need of the controlled substances he prescribed, and that he would sometimes write prescriptions for controlled substances for patients without even examining them.

Medicare Fraud and the Opioid Epidemic

Mr. Fernandez’s case is particularly troublesome because, unfortunately, fraud involving illegal opioid prescriptions is far from unique.

In July, the Justice Department charged more than 400 people in a major crackdown on fraud related to illegal opioid prescriptions. The sting operation focused on doctors and medical clinics that prescribed opioids unnecessarily, even preying on addicts to pay for unnecessary treatments that only worsened their conditions.

“Some doctors wrote out more prescriptions for controlled substances in one month than entire hospitals were writing,” said Acting FBI Director Andrew McCabe in July (McCabe has since returned to his previous role as FBI Deputy Director). “To opioid addicts, these prescriptions escalate their dependence on drugs. They are a death sentence, plain and simple.”

The scams fueled the growing opioid epidemic and resulted in more than $1 billion in false billings. Attorney General Jeff Sessions called it the “largest healthcare fraud takedown operation in American history.” Sessions also said the U.S. prescribes more opioids than any other nation by far.

Indeed, prescription opioid abuse appears to be affecting average life expectancy. A recent study published in JAMA found that the average life expectancy in this country dropped between 2000 and 2015, and opioid overdose deaths are partially to blame.

Startlingly, preliminary data from 2016 shows that the problem is actually getting worse. Drug overdoses climbed from over 52,000 in 2015 to roughly 64,000 in 2016. A data forecast assembled by STAT estimates that as many as 650,000 could die from opioid overdoses alone in the next decade—more people than the entire population of Baltimore, Maryland. If this estimate proves to be even remotely accurate, the average life expectancy in the U.S. will continue to fall.

Whistleblowers a Valuable Weapon to Stop Fraudulent and Illegal Opioid Prescriptions

If the opioid epidemic is going to be contained, let alone stopped, doctors like Mr. Fernandez need to be brought to justice, not only for making this national crisis worse but also for ripping off vital government healthcare agencies in the process. This is where whistleblowers can be weapons for good. If you see a doctor, medical group, or pharmacy overprescribing opioids, you should feel compelled to report it.

Blowing the whistle and exposing the type of fraud outlined above does two things:

  1. It preserves the integrity of our government healthcare programs, which are depended on by millions of Americans.
  2. It combats the opioid epidemic by choking the supply chain, which has the net effect of saving people’s lives.

If that isn’t enough, blowing the whistle on fraud can also bring in a sizeable whistleblower reward. Whistleblowers who bring fraud to the government’s attention are eligible to receive a percentage of any money the government recovers in a successful enforcement action.

To learn more about becoming a whistleblower, check out the ‘How to Blow the Whistle’ page, where whistleblower attorney Mark H. Schlein answers some frequently asked questions.

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