Nurse Practitioner Convicted of $200M Health Care Fraud Scheme

 

A federal jury in Miami convicted a Florida nurse practitioner yesterday for her role in a scheme to defraud Medicare by submitting more than $200 million in false and fraudulent claims for expensive genetic testing and medical equipment that the Medicare beneficiaries did not need.

According to court documents and evidence presented at trial, Elizabeth Hernandez, 45, of Homestead, signed thousands of orders for medically unnecessary orthotic braces and genetic tests, resulting in fraudulent Medicare billings in excess of $200 million. As part of the scheme, telemarketing companies would contact Medicare beneficiaries to convince them to request orthotic braces and genetic tests, and then send pre-filled orders for these products to Hernandez, who signed them, attesting that she had examined or treated the patients. In reality, she had never spoken with many of the patients. In 2020, Hernandez ordered more cancer genetic tests for Medicare beneficiaries than any other provider in the nation, including oncologists and geneticists. She then billed Medicare as though she were conducting complex office visits with these patients, and routinely billed more than 24 hours of “office visits” in a single day. Hernandez personally pocketed approximately $1.6 million in the scheme, which she used to purchase expensive cars, jewelry, home renovations, and travel.

The jury convicted Hernandez of one count of conspiracy to commit health care fraud and wire fraud, in addition to four counts of health care fraud and three counts of making false statements relating to health care matters. She is scheduled to be sentenced on Dec. 14. She faces a maximum penalty of 20 years in prison for conspiracy, 10 years in prison on each health care fraud count, and five years in prison on each false statement count. A federal district court judge will determine any sentence after considering the U.S. Sentencing Guidelines and other statutory factors.

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

The FBI and HHS-OIG investigated this case.

The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program. Since March 2007, this program, comprised of 15 strike forces operating in 25 federal districts, has charged more than 5,000 defendants who collectively have billed federal health care programs and private insurers more than $24 billion. In addition, the Centers for Medicare & Medicaid Services, working in conjunction 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. More information can be found at www.justice.gov/criminal-fraud/health-care-fraud-unit.