Miami Patient Recruiter Pleads Guilty in a $205 Million Health Care Fraud Scheme By Tod Aronovitz | 07/16/14 | 0 Comment

A Miami man, who received kickbacks for recruiting Medicare patients, entered a guilty plea as a result of his connection to a $205 million health care fraud scheme.

According to the U.S. Department of Justice, Michael Mendoza pleaded guilty to one count of conspiracy to commit health care fraud in front of U.S. Magistrate Judge Jonathan Goodman in the Southern District of Florida on June 19.

Court documents report that Mendoza was the president of Network Resource Consultant Inc. while serving as a patient recruiter for Miami-based American Therapeutic Corporation (ATC), a partial hospitalization program (PHP) that claimed to offer intensive psychiatric services.

The 45-year old Mendoza apparently set up an agreement with ATC owner Lawrence Duran, as well as others, to refer residents living in assisted living facilities to ATC in exchange for illegal health care kickbacks. Mendoza’s referrals to ATC were for purported mental health and PHP services for which they did not qualify.

Throughout the course of the conspiracy, millions of dollars in kickbacks were paid in exchange for these assisted living residents. To make the scheme seem legitimate, referrals actually attended treatment programs at ATC which were not justifiable PHP programs.

ATC and other companies involved in the conspiracy then billed 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 referrals alone.

ATC is no longer in business. After pleading guilty, ATC owner Duran was sentenced to 50 years in prison for his role in orchestrating the fraud scheme. Sentencing for Mendoza will take place on August 28.

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees who have knowledge of questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect up to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss your case.