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Mother and Son Duo Plead Guilty to $16 million Medicare Pharmacy Fraud Scheme

August 31, 2016

Yesterday, August 30, 2016, Niurka Fernandez, 54, and her son Roberto Alvarez, 29, both of Miami, each pleaded guilty to one count of conspiracy to commit health care fraud before U.S. District Judge Federico A. Moreno of the Southern District of Florida. They are scheduled to be sentenced November 8, 2016.

In her guilty plea, Fernandez admitted that as owner of two Miami area pharmacies, she was the organizer and leader of a Medicare fraud scheme that paid Medicare beneficiaries and patient recruiters for prescriptions that were medically unnecessary.  She also admitted that she and her co-conspirators billed Medicare for many prescriptions that they never even dispensed to the beneficiaries.

In his guilty plea, Alvarez admitted that he was involved in the Medicare fraud scheme at one of the pharmacies owned by his mother.  Alvarez purported to work there as a pharmacy technician but his actual function was to facilitate kickback payments to Medicare beneficiaries.  Alvarez also admitted to writing checks to money launderers in order to obtain cash to pay kickbacks to Medicare beneficiaries.

Medicare paid over $16 million to the two pharmacies as a result of the health care fraud scheme.

The cases were brought as a part of the Medicare Fraud Strike Force.  Since its inception in March 2007, the Medicare Fraud Strike Force is now operating in nine cities across the country and has charged nearly 2,900 defendants who have collectively billed the Medicare program for more than $10 billion.

The cases against Fernandez and Alvarez are criminal cases.  However, under the qui tam provisions of the False Claims Act, whistleblowers with information about similar fraud against the government may bring a civil case on behalf of the United States. If successful, the government can recover three times the amount the defendants fraudulently billed the government.  The whistleblower, who originally filed the qui tam case, is entitled to 15-30% of the government’s recovery as well as their attorney’s fees.

To report fraud, please contact Frohsin Barger & Walthall.

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