FL Nurse Practitioner Convicted of $200M Fraud Scheme
MIAMI, FL - According to the Department of Justice website, a federal jury in Miami delivered a guilty verdict on September 20, 2023, against a Florida nurse practitioner, Elizabeth Hernandez, 45, on charges related to her involvement in a massive Medicare fraud scheme, resulting in fraudulent claims exceeding $200 million.
About the Fraud Scheme
Shockingly, when you look at all the genetic tests ordered in the U.S., from all providers, in 2020 - Elizabeth Hernandez ordered the most cancer genetic tests for Medicare beneficiaries than all other providers, including oncologists and geneticists.
According to court documents and trial evidence, Hernandez orchestrated a scheme that exploited Medicare through fraudulent billing for medically unnecessary orthotic braces and expensive genetic tests, which led to $200 million in fraudulent Medicare billings. Hernandez used telemarketing companies to persuade Medicare beneficiaries to request unnecessary medical equipment and unwarranted genetic tests. Once the Medicare beneficiaries agreed to the requests, the telemarketers would send pre-filled orders to Hernandez who had never actually spoken to any of the patients. Hernandez would then sign the orders, stating that she had treated or examined those patients, though she hadn't.
She billed Medicare as if she had conducted extensive office visits with these patients, often billing more than 24 hours of "office visits" in a single day. Hernandez personally profited from the scheme, amassing approximately $1.6 million, which she used to fund extravagant purchases, including luxury cars, jewelry, home renovations, and travel.
Convictions and Sentencing
Hernandez faces the following convictions,
- One count of conspiracy to commit health care fraud and wire fraud,
- Four counts of healthcare fraud
- Three counts of making false statements relating to health care matters.
Her sentencing is scheduled for December 14, where she could face the following penalties,
- A maximum sentence of 20 years in prison for conspiracy
- 10 years for each healthcare fraud count
- 5 five years for each false statement count.
The final sentence will be determined by a federal district court judge, who will consider various factors, including U.S. Sentencing Guidelines.
The FBI and HHS-OIG conducted an extensive investigation into this case.
Healthcare Fraud Unit
The Fraud Section leads the Criminal Division’s efforts to combat healthcare fraud through the Health Care Fraud Strike Force Program. Since its launch in March 2007, has charged over 5,000 defendants, collectively responsible for billing federal health care programs and private insurers over $24 billion. Additionally, the Centers for Medicare & Medicaid Services, in partnership with the Office of the Inspector General for the Department of Health and Human Services, are actively working to hold providers accountable for their involvement in healthcare fraud schemes.
