A Florida doctor was sentenced to eight years and one month in jail after a ruling came down to end a healthcare fraud lawsuit.

According to the healthcare fraud lawsuit, the doctor was involved in a $4.8 million healthcare fraud arrangement for six years in which he allegedly submitted false claims to Medicare and wrote illegal prescriptions for different drugs like opioids.

The U.S. Department of Justice filed the healthcare fraud lawsuit against Dr. Roberto A. Fernandez of Miami, who pled guilty to healthcare and wire fraud conspiracy in July 2017. He was sentenced by U.S. District Judge Cecelia M. Altonaga, who also ordered Dr. Fernandez to pay $4.8 million in restitution owed by him and his alleged fellow fraud conspirators.

When Fernandez will be released from prison, he will be under probation for years.

Overview of Healthcare Fraud Lawsuit

According to the healthcare fraud lawsuit, Fernandez pled guilty for his connection to the healthcare fraud scheme running from April 2011 to February 2017. As part of his plea agreement, Fernandez admitted to referring Medicare beneficiaries to specific pharmacies in exchange for illegal kickbacks.

He also admitted he knew the pharmacy owners were billing Medicare and were being reimbursed for these prescriptions. The investigation later revealed that many of these prescriptions were not necessary for the patient’s medical condition.

In an example listed in the healthcare fraud lawsuit, Fernandez stated he prescribed brand name drugs, including HIV and AIDS medications, which conflicted with another set of treatment medications already prescribed to the same Medicare beneficiaries.

Dr. Fernandez also asked his co-conspirators to refer Medicare beneficiaries to his own healthcare practices and had submitted Medicare claims for services he allegedly never provided.

Furthermore, Fernandez had admitted to receiving financial kickbacks for singing off on care plans and prescriptions that were medically unnecessary for the patients. These unnecessary medical care plans included home health services.

Fernandez also admitted to knowing that the patients in question did not need the drugs he prescribed them, and that sometimes he would prescribe these drugs without even examining the patient. Fernandez is expected to begin his jail time soon and will be expected to pay the $4.8 million.

Blowing the Whistle on Healthcare Fraud

This outcome will hopefully encourage other whistleblowers to step forward and report any fraud committed against the federal government. Whistleblower lawsuits are a powerful preventative and recovery tool against fraud, and whistleblowers can be rewarded with between 15% to 30% of whatever settlement may be collected.

In order to be considered a whistleblower, the individual must be the primary source of information of the fraud report. Whistleblower claims are sent directly to the Justice Department for review, after which the government can review and determine whether or not they want to pursue the claim.

Healthcare fraud is one of the most significant forms of fraud the can affect the federal government, as hospitals or even individual physicians can try to exploit the Medicare or Medicaid claim process for financial gain.

This Healthcare Fraud Lawsuit is USA v. Fernandez, Case No. 1:17-cr-20208, in the U.S. District Court for the Southern District of Florida.