Fla. Nurse Practitioner Convicted in $200M+ Medicare Scheme
A Miami-area nurse practitioner has been convicted of defrauding Medicare by submitting fraudulent claims for more than $200 million worth of unnecessary genetic testing and medical equipment, federal prosecutors announced.
Elizabeth Hernandez, 45, of Homestead, could face as many as 75 years in prison when she’s sentenced on December 14.
Hernandez overbilled Medicare by more than $200 million, according to prosecutors who say she ordered more cancer genetic tests for Medicare beneficiaries in 2020 than any other clinician in the nation. She “personally pocketed approximately $1.6 million in the scheme, which she used to purchase expensive cars, jewelry, home renovations, and travel,” prosecutors said.
After a 6-day trial, Hernandez was convicted last week of a single count of conspiracy to commit healthcare fraud and wire fraud, four counts of healthcare fraud and three counts of making false statements relating to health care matters. She was acquitted of two counts of healthcare fraud.
The case is part of an ongoing effort by federal prosecutors to target schemes alleged to have defrauded Medicare of billions of dollars in reimbursement for genetic testing and other health services.
Prosecutors alleged that Hernandez took advantage of the flexible telemedicine rules allowed during the COVID-19 pandemic, and she and another nurse “essentially robo-signed” the orders.
As part of the scheme, telemarketing companies would contact Medicare beneficiaries to convince them to request orthotic braces and genetic tests, and then send pre-filled orders for these products to Hernandez, who signed them, attesting that she had examined or treated the patients, prosecutors said in a statement.
According to prosecutors, Hernandez billed Medicare as if she had performed complex in-person evaluations of patients. The time she attested she spent on these supposed office visits often accounted for more than 24 hours in a day. Prosecutors said Hernandez never examined the patients for whom she ordered $14 million in medical equipment, and that she lied when she certified that she’d personally examined them and determined the supplies were necessary.
Prosecutors also alleged that Hernandez ordered $119 million worth of unnecessary genetic tests for patients she wasn’t treating. The tests include “cancer genetic” (CGx) tests, which look for mutations that may raise the risk of certain diseases, and pharmacogenetic (PGx) tests, which can provide information about how patients will respond to medications.
According to prosecutors, Medicare only rarely covers CGx tests, doing so primarily when a patient has cancer and the patient’s physician orders such tests to improve treatment.
Hernandez also allegedly submitted claims for $1.3 million worth of telemedicine consultations that were not performed.
Prosecutors later put the total amount of fraudulent claims at more than $200 million.
Federal prosecutors also alleged that several companies that claimed to be in the telemedicine business gave bribes and kickbacks to Hernandez.
In recent years, federal officials have increasingly targeted schemes to defraud Medicare through fake claims for genetic testing. In 2020, for instance, prosecutors charged 345 defendants, including more than 100 doctors, nurses and other licensed medical professionals, with submitting more than $6 billion in fraudulent claims for genetic testing and other services.
Last December, a Georgia man was convicted in a scheme alleged to have cost Medicare $463 million. He was accused of having “conspired with patient brokers, telemedicine companies, and call centers to target Medicare beneficiaries with telemarketing calls falsely stating that Medicare covered expensive cancer genetic tests,” according to a statement from federal prosecutors.
In a 2021 report, the inspector general of the US Department of Health & Human Services warned that a sharp rise in Medicare payments for genetic tests could be a sign of fraud even as federal guidance related to coverage for genetic testing has been inconsistent. The payments quadrupled to $1.41 billion from 2016 to 2019.
Randy Dotinga is a freelance medical writer and board member of the Association of Health Care Journalists.
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