Pharmacy Owner and Son Plead Guilty to $16M Pharmacy Medicare Fraud Scheme

A pharmacy owner and her son have admitted to orchestrating a $16 million Medicare fraud scheme at 2 Miami pharmacies.

Niurka Fernandez, 54, and her son, Roberto Alvarez, 29, carried out their fraudulent plan at Fernandez’s personally owned pharmacies, Calan Pharmacy & Discount Service LLC and Bertyann Corp, also known as Best Pharmacy. Through this scheme, Fernandez and her co-conspirators led Medicare to pay beneficiaries and patient recruiters for medically unnecessary prescriptions, and also billed Medicare for many prescription medications that were never dispensed.

Alvarez worked at Best Pharmacy under the guise of a pharmacy technician while he really facilitated kickback payments to Medicare beneficiaries, according to his guilty plea. He admitted to writing checks to money launderers in an effort to receive cash to pay the kickbacks to Medicare beneficiaries.

As a result of this scheme, Medicare made more than $16 million in overpayments to Calan Pharmacy and Best Pharmacy, according to admissions made in connection with the duo’s pleas.

Fernandez and Alvarez each pleaded guilty to 1 count of conspiracy to commit health care fraud before US District Judge Federico A. Moreno of the Southern District of Florida. Their sentencings are scheduled for November 8, 2016.

This case was brought by the Medicare Fraud Strike Force, which is now operating in 9 cities across the country and has charged nearly 2000 defendants who have collectively billed Medicare for more than $10 billion, according to the US Department of Justice. Last month, a health care fraud investigation initiated by the strike force led to charges of a compounding pharmacy fraud scheme at a number of Florida-based pharmacies.

The strike force also investigated a scam that led to the recent sentencing of a Florida man to 20 years in federal prison and $36.4 million in restitution, Law360 reported. Khaled Elbeblawy, 40, is among the 243 individuals nationwide who were arrested by the strike force 7 months ago. He was charged for his role in a $57 million Medicare fraud scheme.