A South Florida advanced registered nurse practitioner convicted for her role in a healthcare fraud scheme that billed Medicare more than $200 million in false and fraudulent claims, faces the possibility of decades behind bars.
Thousands of Fraudulent Orders Signed
Elizabeth Hernandez of Homestead was indicted in April 2022 on ten counts relating to her healthcare fraud scheme. According to evidence presented at trial, Hernandez, who was licensed in at least 28 states, including Florida, signed thousands of orders for medically unnecessary orthotic braces and genetic tests.
On Sept. 20, she was found guilty by a Miami federal jury of one count of conspiracy to commit healthcare fraud and wire fraud, in addition to four counts of healthcare fraud and three counts of making false statements relating to healthcare matters.
Soliciting and Receiving Kickbacks
According to the indictment, between August 2018, through June 2021 Hernandez worked with Michael Stein and others by, among other things, soliciting and receiving kickbacks and bribes in exchange for signing doctors’ orders for orthotic braces and genetic testing that was medically unnecessary and not legitimately prescribed.
In April, just before his trial was to begin, Stein pleaded guilty to his part of the healthcare fraud scheme. He was indicted in 2021. Stein ran two companies â€“ 1523 Holdings and Growthlogix â€“ that paid healthcare providers bribes and kickbacks to order genetic tests that were medically unnecessary.
The Healthcare Fraud Scheme
As part of her Medicare fraud 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 thousands of them, attesting that she had examined or treated the patients. However, she had never spoken with many of the patients. In exchange for signing the orders she received kickbacks and bribes from the purported telemedicine companies.
Genetic Testing Fraud
In 2020, Hernandez also ordered more cancer genetic tests for Medicare beneficiaries than any other provider in the country, including oncologists and geneticists. She then billed Medicare as though she were conducting complex office visits with these patients. In this Medicare fraud scheme, she routinely billed more than 24 hours of â€œoffice visitsâ€ in a single day. According to the indictment, Hernandez billed $200 for the office visits and thousands of dollars for the genetic tests.
Hernandez pocketed approximately $1.6 million in the healthcare fraud scheme, which she used to purchase expensive cars, jewelry, home renovations, and travel.
Sentencing to End in Jail Time
Hernandez is scheduled to be sentenced on Dec. 14 and faces up to 20 years in prison for the conspiracy charge, 10 years in prison on each healthcare fraud count, and five years in prison on each false statement count.
In 2019, the Department of Health and Human Services Office of Inspector General sent out an alert about genetic testing fraud schemes.
Scammers often target Medicare beneficiaries through telemarketing calls, booths at public events, health fairs, and door-to-door visits. They offer “free” genetic testing to help recipients avoid diseases or find the right medications. In some cases, Medicare will cover the tests, but in others it will not, and the patient will be liable for the cost which could be in the thousands of dollars.
Any test must be ordered by a physician be and medically necessary to be covered by Medicare and other payors. The American Bar Association has referred to genetic testing scams as the â€œNew Wild West for Healthcare Fraud.â€
Healthcare Providers Beware
Healthcare providers should be advised that accepting remuneration in return for ordering unnecessary tests is a violation of the Anti-kickback law and can land them in jail, subject them to fines and even result in the loss of their license.
The Health Law Offices of Anthony C. Vitale can provide you with compliance oversight services, assuring that your business relationships are compliant with all federal and state fraud, waste and abuse laws. We also represent healthcare professionals in state and federal court who are charged with fraudulent billing, kickbacks, Medicare and Medicaid fraud and false claims, among others.
What We Can Do for Healthcare Providers
Our team of highly skilled attorneys and consultants can assist before you become the focus of an investigation and will aggressively defend you should you become the target of one.
Give us a call at 305-358-4500, or send an email to firstname.lastname@example.org and letâ€™s discuss how we might be able to assist you.