Patient Recruiter Pleads Guilty in Miami for Role in $205 Million Health Care Fraud Scheme

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A former patient recruiter pleaded guilty today in Miami, Florida, for his role in a $205 million Medicare fraud scheme.

Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division, U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida, Special Agent in Charge George Piro of the FBI’s Miami Field Office and Acting Special Agent in Charge Ryan Lynch of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office made the announcement.

Michael Mendoza, 45, of Miami, Florida, pleaded guilty before U.S. Magistrate Judge Jonathan Goodman in the Southern District of Florida to one count of conspiracy to commit health care fraud.

 Sentencing is scheduled for Aug. 28, 2014.

According to court documents, during the course of the conspiracy, Mendoza was the president of Network Resource Consultant Inc., a Florida corporation, and he served as a patient recruiter for American Therapeutic Corporation (ATC), a defunct partial hospitalization program located in Miami that purported to provide intensive psychiatric services.

  Mendoza made an agreement with Lawrence Duran, the owner of ATC, and others to refer residents living in assisted living facilities throughout the Southern District of Florida to ATC in exchange for illegal health care kickbacks.

 Mendoza’s referrals to ATC were for purported mental health services.

Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries, who did not qualify for PHP services, to attend treatment programs that were not legitimate PHP programs so that ATC and related companies could bill Medicare for more than $205 million in medically unnecessary services.

 

ATC submitted approximately $436,450 in false and fraudulent claims to Medicare for Mendoza’s beneficiary referrals.

Duran pleaded guilty and was sentenced to serve 50 years in prison for his role in orchestrating the fraud scheme.

This case is being investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal

Division’s Fraud Section and the U.S. Attorney’s Office for the Southern District of Florida.  

This case was prosecuted by Assistant Chief Robert Zink and Trial Attorney Allan J. Medina of the Criminal Division’s Fraud Section.

Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged nearly 1,900 defendants who have collectively billed the Medicare program for more than $6 billion.

  In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, is taking steps to increase accountability and decrease the presence of fraudulent providers.

To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov

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