Michael Mendoza, Conspiracy to Commit Health Care Fraud, Miami FL, …

MIAMI, FL – Another cog in a massive healthcare fraud machine admitted guilt today, bringing a small measure of accountability to a $205 million scheme that bilked Medicare. Michael Mendoza, 45, of Miami, pleaded guilty to one count of conspiracy to commit health care fraud before U.S. Magistrate Judge Jonathan Goodman in the Southern District of Florida. Sentencing is slated for August 28, 2014.

The case, a product of the Medicare Fraud Strike Force, reveals a cynical operation where vulnerable patients in assisted living facilities were funneled into American Therapeutic Corporation (ATC), a now-defunct Miami partial hospitalization program. Mendoza, as president of Network Resource Consultant Inc., allegedly agreed with ATC owner Lawrence Duran and others to receive illegal kickbacks for referring these residents – many of whom didn’t even *need* the services – for purported mental health treatment.

Federal investigators say ATC wasn’t providing legitimate psychiatric care. It was a sham designed to inflate Medicare billings. The scheme involved millions in kickbacks paid for sending Medicare beneficiaries into a program for medically unnecessary services. Specifically, ATC submitted approximately $436,450 in fraudulent claims tied directly to Mendoza’s referrals. This wasn’t a victimless crime; it siphoned taxpayer money and potentially denied legitimate patients access to crucial care.

This guilty plea follows that of Duran, who was already sentenced to a hefty 50 years in prison for masterminding the entire fraud. While Mendoza’s sentence remains pending, his admission of guilt is a significant step in dismantling the network of individuals who profited from this elaborate deception. The investigation was a joint effort by the FBI’s Miami Field Office and the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG).

U.S. Attorney Wifredo A. Ferrer of the Southern District of Florida and Assistant Attorney General Leslie R. Caldwell of the Justice Department’s Criminal Division announced the guilty plea, emphasizing the ongoing commitment to combating healthcare fraud. Assistant Chief Robert Zink and Trial Attorney Allan J. Medina of the Criminal Division’s Fraud Section prosecuted the case. The Medicare Fraud Strike Force, active in nine cities nationwide, has charged nearly 1,900 defendants responsible for over $6 billion in fraudulent claims since its inception in 2007.

The government continues to crack down on fraudulent providers, with HHS’s Centers for Medicare and Medicaid Services working alongside HHS-OIG to increase accountability. Anyone with information about healthcare fraud is encouraged to visit www.stopmedicarefraud.gov. Further details and court documents can be found on the websites of the United States Attorney’s Office for the Southern District of Florida (http://www.usdoj.gov/usao/fls) and the District Court for the Southern District of Florida (http://www.flsd.uscourts.gov or http://pacer.flsd.uscourts.gov).