Medicare Fraud Spotlight

It was recently reported that the Iowa Board of Nursing revoked the license of an Iowa nurse in June of 2024. Elizabeth Hernandez, an advanced registered nurse practitioner, was sentenced to 20 years in prison in September 2023 after being convicted of seven federal offenses involving wire fraud and health care fraud. Prosecutors stated that Hernandez collected $1.6 million from a $192 million fraudulent billing scheme over the course of three years.

Many of Hernandez’s false claims involved prescribing expensive and medically unnecessary genetic tests and durable medical equipment (DME) to thousands of Medicare beneficiaries she’d never spoken to. Federal prosecutor Andrea Savdie stated that Hernandez filed false claims to Medicare, at times amounting to more than 24 hours’ worth of telehealth service appointments in one day. While reports from the Florida investigators stated that Hernandez ordered more cancer genetic tests for Medicare beneficiaries than any other provider in the nation. Savdie told the court that the nurse had five cars and had spent $66,000 on jewelry, spas, and facials during the three-year period of the scam, and that she also took her entire family to Lake Tahoe right before her trial in this case.

Telehealth, genetic testing, and DME fraud are unfortunately far too common in Iowa. To help prevent and detect suspected Medicare fraud, errors, and abuse, Iowa Senior Medical Patrol (SMP) encourages beneficiaries to review their Medicare statements regularly and to report any suspicious claims. “When the annual cost of Medicare fraud, errors, and abuse amounts to over $100 billion per year, it’s so important to be vigilant and report suspicious claims,” says Marlú Abarca, SHIIP-SMP Caseworker and Outreach Specialist.   As this case illustrates fraud can occur even if the Medicare beneficiary has never spoken to the fraudster! “If you find a billing error on your Medicare statement, you can call your provider to correct the error. If you notice a charge for a service you never received, or by a provider you’ve never spoken to, reach out to SHIIP-SMP and we’d be happy to help you resolve your concern.”

Beneficiaries can reach out to SHIIP-SMP via email at ship@iid.iowa.gov or by phone at 1-800-351-4664 TTY (Teletypewriter) users can call 1-877-486-2048. Additionally, beneficiaries can reach Medicare 24/7 at 1-800-633-4227.

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