A federal jury in Miami has delivered a verdict with significant consequences, convicting a Florida nurse practitioner for her pivotal role in a scheme that defrauded Medicare of more than $200 million through fraudulent claims for genetic testing and unnecessary medical equipment.
Elizabeth Hernandez’s Deceptive Actions
The conviction centered on Elizabeth Hernandez, aged 45, residing in Homestead, Florida.
Evidence presented during the trial and court documents reveal that Hernandez was responsible for signing thousands of orders for orthotic braces and genetic tests that were medically unnecessary.
This deceitful action resulted in Medicare being billed for over $200 million in fraudulent claims.
The Elaborate Scheme
The fraudulent scheme involved telemarketing companies contacting Medicare beneficiaries to persuade them to request orthotic braces and genetic tests.
Subsequently, pre-filled orders for these items were sent to Hernandez.
She would then sign these orders, falsely asserting that she had examined or treated the patients. In many cases, she had never even spoken to the patients directly.
Unprecedented Billing and Personal Gain
In the year 2020, Hernandez ordered more cancer genetic tests for Medicare beneficiaries than any other healthcare provider in the nation, surpassing even oncologists and geneticists.
Her fraudulent billing practices included routinely claiming more than 24 hours of “office visits” in a single day.
As a result of her actions, Hernandez personally profited approximately $1.6 million, which she used to fund a lavish lifestyle, including purchasing expensive cars, jewelry, home renovations, and extensive travel.
The federal jury convicted Hernandez on multiple counts, including one count of conspiracy to commit health care fraud and wire fraud, four counts of health care fraud, and three counts of making false statements related to health care matters.
Her sentencing is scheduled for December 14, where she faces a maximum penalty of 20 years in prison for conspiracy, 10 years in prison for each health care fraud count, and five years in prison for each false statement count.
The final sentence will be determined by a federal district court judge, considering sentencing guidelines and statutory factors.
Announcement by Justice Department and Investigative Agencies
The announcement of Hernandez’s conviction was made by 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).
Investigation and Prosecution
This case was thoroughly investigated by the FBI and HHS-OIG. The prosecution of the case is being handled by Trial Attorney Andrea Savdie and Assistant Chief Kate Payerle of the Criminal Division’s Fraud Section.
Combating Health Care Fraud
The Fraud Section leads the Criminal Division’s efforts to combat health care fraud through the Health Care Fraud Strike Force Program.
This program, operating across 25 federal districts with 15 strike forces, has successfully charged over 5,000 defendants since March 2007, collectively billing federal health care programs and private insurers for more than $24 billion.
Collaborative efforts with the Centers for Medicare & Medicaid Services and the Office of the Inspector General for the Department of Health and Human Services aim to hold providers accountable for their involvement in health care fraud schemes.