Nurse Practitioner Convicted of $200M Health Care Fraud Scheme

 

   A Florida nurse practitioner was found guilty yesterday by a federal jury in Miami for her part in a plot to cheat Medicare by filing more than $200 million in fictitious and fraudulent claims for pricey genetic testing and medical equipment that the Medicare beneficiaries did not require.

Elizabeth Hernandez, 45, of Homestead, allegedly authorized thousands of requests for genetic tests and medically unnecessary orthotic braces, resulting in false Medicare billings totaling more than $200 million, as per court records and the evidence presented at trial. Telemarketing firms would call Medicare beneficiaries as part of the scam to persuade them to order orthotic braces and genetic tests, then send Hernandez pre-filled orders for these products, with her signature attesting that she had seen or treated the patients. She had actually never spoken to several of the sufferers. Including oncologists and geneticists, Hernandez requested more cancer genetic tests for Medicare patients in 2020 than any other healthcare professional in the country. After that, she consistently billed Medicare for more than 24 hours of "office visits" in a single day while acting as though she were performing complicated office appointments with these patients. Hernandez personally received about $1.6 million from the plan, which she spent on pricey cars, jewelry, home improvements, and other things.

 Hernandez was found guilty by the jury of four charges of health care fraud, three counts of making false statements about health-related issues, and one count each of conspiracy to commit wire fraud and health care fraud. On December 14, she is due to receive her punishment. She could receive a sentence of up to 20 years in jail for conspiring, 10 years on each count of health care fraud, and 5 years for each charge of making false statements. After taking into account the U.S. Sentencing Guidelines and other legal considerations, a federal district court judge will decide on any sentence.

  The announcement was made by Christian J. Schrank, the Deputy Inspector General for Investigations at the Department of Health and Human Services Office of Inspector General (HHS-OIG), Nicole M. Argentieri, the Acting Assistant Attorney General for the Criminal Division of the Justice Department, and Assistant Director Luis Quesada of the FBI's Criminal Investigative Division.

The situation was looked into by the FBI and HHS-OIG.

The case is being prosecuted by Trial Attorney Andrea Savdie and Assistant Chief Kate Payerle of the Criminal Division's Fraud Section.

 

   The Criminal Division's fight against health care fraud is coordinated by the Fraud Section through the Health Care Fraud Strike Force Program. Since March 2007, this operation, comprising of 15 strike groups operating in 25 federal districts, has accused more than 5,000 individuals who cumulatively have billed federal health care programs and private insurers more than $24 billion. In addition, the Centers for Medicare & Medicaid Services, working in partnership with the Office of the Inspector General for the Department of Health and Human Services, are taking steps to hold providers accountable for their involvement in health care fraud schemes.