Loyola University Chicago School of Law, JD 2018
Niurka Fernandez, 54, and her son Roberto Alvarez, 26, both plead guilty on August 31, 2016 to one count of conspiracy to commit health care fraud. On November 10th, Fernandez was sentenced to 120 months in prison while Alvarez was sentenced to serve 30 months in prison. Additionally, Fernandez was ordered to pay $9.5 million dollars in restitution and to forfeit the same amount. Alvarez was ordered to do the same, except at a lesser value of $1.5 million.
Fernandez was not only the owner of Miami-Dade County pharmacies, Calan Pharmacy, Discount Service LLC, and the Bertyann Corporation known as Best Pharmacy, but she was also the ring leader and organizer of this Medicaid fraud scheme. According to the government, both Fernandez and her son paid Medicaid beneficiaries and patient recruiters for prescriptions that were not medically necessary. The duo also billed Medicare for other prescription medications that were never dispensed to the alleged beneficiaries.
Alvarez, while representing himself as a pharmacy technician at Best Pharmacy, facilitated kickback payments to Medicare patients and wrote checks to money launderers in order to get cash for these kickbacks. Medicare kickbacks occur when health care providers intentionally accept payments, products or services for the purpose of soliciting Medicare or health care program businesses. As a result of this family scheme, Medicare paid more than 16 million dollars to Best Pharmacy and Calan Pharmacy. Fernandez directed her son to write these fraudulent checks. This scheme ran from approximately September 2012 until March 2016.
Miami has been a hot-spot for Medicare fraud. The biggest healthcare fraud takedown took place in June of this year, where the Department of Justice charged 301 individuals nationwide. Out of the defendants charged, 100 were from the Southern District of Florida. The majority of the 100 charged were from Miami.
This investigation was brought about by the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the U.S. Attorney’s Office of the Southern District of Florida. The Medicare Fraud Strike Force operates in nine areas throughout the country: Miami, Florida; Los Angeles, California; Detroit, Michigan; southern Texas; Brooklyn, New York; southern Louisiana; Tampa, Florida; Chicago, Illinois; and Dallas, Texas. Since its creation, the Medicare Fraud Strike Force, has charged almost three thousand defendants, who collectively billed the Medicare program for more than $10 billion. HHS centers for Medicare and Medicaid Services, have been working along with the HHS-OIG to take steps to increase accountability for these fraudulent activities of health care providers. These agencies are also working to decrease the presence of fraudulent providers in these health care systems and programs.