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DOJ: Florida Nurse Practitioner Guilty in $200 Million Fraud Case

Department of Justice

A Florida nurse practitioner has been convicted in a $200 million Medicare fraud scheme.

Elizabeth Hernandez, 45, took part in a scheme to defraud the government by submitting phony claims for genetic testing and medical equipment that the Medicare beneficiaries did not need, the U.S. Department of Justice (DOJ) said in a news release Thursday (Sept. 21).

“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,” the release said. “In reality, she had never spoken with many of the patients.”

According to the release, Hernandez in 2020 ordered more cancer genetic tests for Medicare recipients than any other provider in the nation, including oncologists and geneticists.

She then billed Medicare as if she was “conducting complex office visits with these patients,” routinely billing more than 24 hours of “office visits” in a single day, the release said.

The DOJ says Hernandez personally pocketed approximately $1.6 million, using the funds to travel, renovate her home and buy expensive cars and jewelry.

Hernadnez was convicted in federal court in Miami of conspiracy to commit healthcare fraud and wire fraud, in addition to four counts of healthcare fraud and three counts of making false statements relating to healthcare matters. She is scheduled to be sentenced on Dec. 14 and could spend decades in prison.

Meanwhile, PYMNTS looked earlier this week at the prevalence of fraud, especially thanks to the advent of generative artificial intelligence (AI).

PYMNTS intelligence finds that fraud has risen for 43% of financial institutions (FIs) compared to 2022, with the average cost of fraud jumping by 65% for FIs with assets of $5 billion or more.

“One of the reasons for the recent uptick in fraud is that new generative AI capabilities are giving bad actors more avenues to activate historic vulnerabilities, allowing them access to sophisticated approaches — such as the use of synthetic digital identities and AI voice clones — that were once relegated to the realm of true professional crime syndicates,” the report said.

Until recently, fraudsters had to have some technical know-how to craft a malicious code,  Michael Jabbara, vice president and global head of fraud services at Visa, told PYMNTS.

“But now,” he said, “there’s been a democratization of fraud, where anyone can buy the tools and the tutorials they need to carry out successful attacks.”