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Nurse Practitioner Convicted in $200 Million Medicare Fraud Scheme

Posted  September 28, 2023

In a landmark healthcare fraud case, a federal jury in Miami has convicted a nurse practitioner $200 million for her central role in a massive Medicare fraud scheme in which she conspired with telemarketing companies to submit false claims for unnecessary genetic testing and medical equipment.

Evidence presented during trial outlined the scheme: telemarketers targeted Medicare beneficiaries, and pressured them to request orthotic braces and genetic tests they didn’t need, then without ever examining or treating these patients, Hernandez signed thousands of orders for these products and testing. She also billed Medicare as though she were conducting complex office visits, routinely billing more than 24 hours of “office visits” in a single day.

Elizabeth Hernandez personally pocketed $1.6 million from the scheme, which she spent on high-end automobiles, valuable jewelry, home improvements, and extensive travel.

The jury convicted Hernandez on multiple charges, including one count of conspiracy to commit health care fraud and wire fraud, along with four counts of health care fraud and three counts of making false statements related to health care matters. Hernandez faces a maximum prison sentence of 20 years for conspiracy, with an additional 10 years for each health care fraud count and five years for each false statement count. She will be sentenced on December 14.

Both the FBI and HHS-OIG conducted the investigation, and the prosecution was led by the Criminal Division’s Fraud Section, which plays a pivotal role in combating healthcare fraud through the Health Care Fraud Strike Force Program (the Program). The Program is responsible for recovering more than $24 billion in fraudulent billings to federal health care programs and private insurers.

Whistleblowers also play a key role in busting this type of healthcare fraud. Under the qui tam provisions of the False Claims Act, whistleblowers have recovered billions of dollars in whistleblower rewards and have been responsible for tens of billions of dollars in government recoveries.

If you would like more information on what it means to be a whistleblower or think you may have information relating to healthcare fraud, government contract fraud, or any other kind of fraud or misconduct involving a government program, please feel free to contact us so we can connect you with a member of the Constantine Cannon whistleblower lawyer team for a free and confidential consultation.

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Tagged in: FCA Federal, Healthcare Fraud, Lack of Medical Necessity, Medical Devices and DME, Medicare,