Miami nurse gets 20 years in $192M Medicare fraud case involving genetic tests for cancer [Miami Herald]

Miami Herald (FL)

A Miami-area nurse practitioner on Thursday was sentenced to 20 years in prison for illegally signing thousands of orders for medical equipment and genetic tests while submitting $192 million in false claims to the taxpayer-funded Medicare program.

Elizabeth Hernandez, 45, of Homestead was found guilty of playing a central role in a scheme involving telemarketing companies that contacted and convinced Medicare patients to request unnecessary medical products and services, including orthotic braces and genetic tests for cancer.

The companies then sent pre-filled orders for the products to Hernandez, who signed them while falsely stating she had examined or treated the patients, federal prosecutors said. Hernandez billed Medicare as though she were conducting complex office visits with the patients, most of whom she never spoke to or saw. Prosecutors said she routinely submitted claims to the federal insurance program for more than 24 hours of “office visits” in a single day.

“In 2020, Hernandez ordered more cancer genetic tests for Medicare beneficiaries than any other provider in the nation, including oncologists and geneticists,” the Justice Department said in a news release following the jury’s verdict in September. A Miami federal jury convicted Hernandez of one count of conspiracy to commit healthcare fraud and wire fraud, along with four counts of healthcare fraud and three counts of making false statements.

At Thursday’s sentencing, U.S. District Judge K. Michael Moore ordered the nurse practitioner to repay the government about $1.6 million that she had pocketed and spent it on expensive cars, jewelry, home renovations and travel.

Although Hernandez went to trial alone, she collaborated with other South Florida telemedicine operators who already pleaded guilty and were sentenced to prison.

Michael Stein, 36, of Lake Worth, pleaded guilty in April to conspiring to defraud the U.S. government by soliciting and receiving kickbacks from another South Florida man who co-owned Panda Conservation Group. The Texas-based company operated two genetic testing labs that billed $90 million to the Medicare program and received $60 million in payments between April and November 2020.

In June, Stein was sentenced to five years in prison and ordered to pay $63.3 million in restitution to Medicare by U.S. District Judge Cecilia Altonaga.

Stein and Panda’s co-owner, Leonel Palatnik, were accused of conspiring to fleece the U.S. government’s insurance program for senior citizens and indigent by exploiting waivers granted to telemedicine providers during the COVID-19 pandemic, prosecutors said.

In 2021, Palatnik, 44, of Aventura, pleaded guilty to defrauding Medicare and paying kickbacks to Stein as part of their scheme to bill the federal insurance program for thousands of unnecessary lab tests at Panda. Palatnik was sentenced to nearly seven years.

As part of his plea deal, Palatnik admitted that he paid $50,000 a month in kickbacks to Stein, owner of 1523 Holdings LLC in Hollywood, in exchange for his arranging for telemedicine providers to approve genetic testing orders for patients at Panda’s labs — orders signed by Hernandez, the nurse practitioner.