More Medicare Part D Fraud in Miami

On November 8, 2016, the United States Attorney’s Office for the Southern District Florida announced the conviction and sentencing of two defendants in a Medicare Part D fraud case.

What is Medicare Part D?

As most people know, Medicare is a federally funded program that provides free or below-cost healthcare benefits to certain individuals, primarily the elderly, blind, and disabled. Medicare offers different types of benefits through program “parts.” Part D of Medicare, known as the Medicare Part D program, subsidizes the costs of prescription drugs for Medicare beneficiaries in the United States.

In order to receive Part D benefits, a beneficiary must enroll in a Medicare Part D drug plan. These drug plans are operated by private insurance companies known as drug plan sponsors. Some common Medicare Part D drug plan sponsors include Optimal RX, CVS Caremark, Express Scripts, United American Insurance Company, and United Healthgroup.

The case recently prosecuted in Miami was titled United States v. Niurta Fernandez & Roberto Alvarez, case number 16–20391–CR-Moreno. According to the government’s press release, the two defendants — a mother and son — operated a fraudulent scheme to submit medically unnecessary drug prescriptions to Medicare Part D plan sponsors, paid for by the government.

Unfortunately, these types of schemes are all too common in South Florida and elsewhere. Basically, a group of conspirators generate bogus prescriptions for drugs that are actually delivered to patients who do not need the drugs and very often throw the drugs in the trash. These schemes commonly involve the following types of conduct:

• Paying cash or other kickbacks to “recruiters” who go into the community and recruit Medicare beneficiaries who are willing to receive medically unnecessary prescription drugs.
• Paying cash or other kickbacks to Medicare beneficiaries who receive the medically unnecessary drugs. The patient might not need or want the drugs. The patient agrees to receive the drugs only because he or she is getting a cash kickback to do so.
• Paying cash or other kickbacks to a doctor who will sign the prescription for the medically unnecessary drugs. Yes, unscrupulous doctors will write prescriptions in exchange for a fee.

The government’s press release in the Fernandez case does not indicate the full details of the scheme, but does indicate that the case involved kickbacks to patient recruiters and to Medicare beneficiaries. According to the press release, Medicare paid at least $9.5 million in overpayments as a result of the fraudulent activities of these two defendants. The defendants were ordered to pay these losses back to the government in restitution, although it is unclear whether they have actually done so. Very often, the defendants in criminal cases have squandered the money or have hidden it away so that the government never gets it back.

Blow the Whistle on Medicare Part D Fraud in Florida

If you think you know about a potential fraud against the Medicare Part D program, contact one of our Florida Whistleblower lawyers at Rabin Kammerer Johnson or call 877-915-4040 for a free and confidential consultation. You may be entitled to become a whistleblower under the False Claims Act and to receive a reward for your efforts.