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Two Individuals Sentenced for Roles in Miami-Area Medicare Fraud

The Department of Justice, the FBI and the Department of Health and Human Services announced that two Miami-area residents, James Edwards and Nelson Fernandez, were recently sentenced for their roles in a $200 million Medicare fraud scheme.

Edwards and Fernandez worked as patient-recruiters for American Therapeutic Corporation (“ATC”), Medlink Professional Management Group, Inc., its management company, and the America Sleep Institute (“ASI”), a related entity. All three Florida corporations were based in Miami. ACT ran several partial hospitalization programs, used to treat severe mental illness, in South and Central Florida. ASI offered sleep disorder diagnostic testing.

Edwards and Fernandez both pleaded guilty in 2011 to recruiting Medicare patients for the companies in exchange for per patient, per day kickbacks. According to court documents, Edwards and Fernandez were part of a large Medicare kickback scheme by ATC’s and ASI’s owners and operators that defrauded the federal government out of hundreds of millions of dollars.

According to the DOJ, Edwards and Fernandez admitted to causing the submission of more than $16 million in fraudulent invoices to Medicare. Court documents reflect that they knew the Medicare beneficiaries they recruited for the companies’ partial hospitalization programs and diagnostic sleep disorder testing were ineligible for the programs.

Edwards was sentenced to 84 months in prison and ordered to pay $4.1 million in restitution, joint and several with his co-conspirators. Fernandez was sentenced to 63 months in prison and ordered to pay $13.1 million in restitution, joint and several with his co-conspirators. ATC, Medlink and 19 other individuals have already been convicted or have pleaded guilty for their roles in the scheme. The remaining individuals are set for trial in October.

If you have any firsthand knowledge, information, or evidence related to any federal, state, county or city government fraud, you should speak with an experienced qui tam lawyer who can help you understand your legal rights and help you obtain the compensation you deserve.

If you have a claim, contact the Florida whistleblower attorneys at McCabe Rabin, P.A. for a free and confidential consultation by calling toll free at 877.915.4040 or e-mail kelly@mccaberabin.com.

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