U.S. District Judge Virginia Hernandez Covington has sentenced Ruth Bianca Fernandez (39, Pompano Beach) to three years in federal prison for her role in a conspiracy to commit health care fraud and for making a false statement in a matter involving a federal health care benefit program.
As part of her sentence, the court ordered Fernandez to pay approximately $12 million to the affected government health programs and an insurance company, which obligation is joint and several with other coconspirators. The court also entered an order of forfeiture against Fernandez in the amount of $62,650. Fernandez had pleaded guilty on October 18, 2021.
According to court documents, beginning in January 2018 and continuing into April 2019, Patsy Truglia, previously sentenced to a 15-year term of imprisonment, Fernandez, who worked directly under Truglia’s supervision and direction, and other conspirators generated medically unnecessary physicians’ orders via their telemarketing operation for certain orthotic devices—knee braces, back braces, wrist braces, and other braces—referred to as durable medical equipment (“DME”).
Through the telemarketing operation, federal health care program beneficiaries’ (i.e., Medicare beneficiaries’) personal and medical information was harvested to create the unnecessary DME brace orders. The brace orders were then forwarded to purported “telemedicine” vendors that, in exchange for a fee, paid illegal bribes to physicians to sign the orders, often without ever contacting the beneficiaries to conduct the required telehealth consultations.
The fraudulent, illegal brace orders were then returned to Truglia’s telemarketing operation, which used the orders as support for millions of dollars in false and fraudulent claims submitted to the Medicare program. To avoid Medicare scrutiny, Truglia and Fernandez spread the fraudulent claims across five DME storefronts operated under Truglia’s control and Fernandez’s day-to-day management. In all, through their five storefronts, Truglia, Fernandez, and other conspirators caused approximately $25 million in fraudulent DME claims to be submitted to Medicare, resulting in approximately $12 million in payments.
“Submitting fraudulent claims to Medicare for medically unnecessary equipment diverts funding meant to cover the cost of caring for vulnerable beneficiaries,” stated Special Agent in Charge Omar Pérez Aybar with the U.S. Department of Health and Human Services Office of Inspector General. “Our agency will continue to work with our law enforcement partners to identify and hold accountable bad actors who commit health care fraud.”
“This investigation reflects the FBI’s continuing efforts to safeguard Federal healthcare programs from greed-fueled fraud schemes,” said FBI Tampa Division Special Agent in Charge David Walker.
“This sentence today holds the defendant accountable for her role in a fraud scheme that bilked federal healthcare programs out of millions of dollars. The VA OIG is committed to rooting out fraud committed against healthcare programs for veterans and their families,” said Special Agent in Charge David Spilker of the VA Office of Inspector General’s Southeast Field Office. “We commend the collaborative efforts of our law enforcement partners in this important joint investigation.”
“Health care fraud is not a victimless crime. We all pay in multiple ways: the U.S. Treasury loses tens of billions of dollars per year and higher health care premiums are passed on to patients as a result of these scams,” said IRS-CI Acting Special Agent in Charge Ronald A. Loecker. “IRS-CI and our federal partners take the criminal acts committed by this defendant, and others, very seriously and will continue to follow fraudulent money flows no matter the underlying crime.”