No Winners

27460164 - a man wearing a suit with his wrists handcuffed in the back

To pull off a scheme capable of stealing $205 million from Medicare, there’s usually a multitude of players involved in a game that robs the elderly and the poor of medical benefits. An article posted on covers a man who was responsible for submitting more than $430,000 in false claims as part of the overall scheme.

The story states that a 45-year-old man was a patient recruiter for a now out-of-business partial hospitalization program (PHP) that purportedly provided intensive psychiatric services. The owner of the Miami-based business paid illegal health care kickbacks to the recruiter in exchange for patient referrals for residents at assisted living facilities throughout the Southern District of Florida. (As you might guess, the patients did not qualify for services and the PHP was not legitimate.)

The South Florida man pleaded guilty to one count of conspiracy to commit health care fraud. He is facing up to 10 years in prison when sentenced. (It is important to note that the owner of the company that this patient recruiter worked for is now serving 50 years in prison for masterminding the scheme.)

What might have started out as a game in the mind of the perpetrators, ended up having no winners – only losers. Because of the crimes committed by the owner and the patient recruiter, the poor and the elderly have lost out on deserved benefits. However, these two will also pay a high price for their selfish acts and will be unlikely to obtain a ”get out of jail free card” anytime soon.

Source: Today’s ”Fraud of the Day” is based on an article entitled ”Michael Mendoza Guilty in $205 million Medicare fraud scheme by recruiting patients for kickbacks” published on on June 20, 2014.

MIAMI – A South Florida man has pleaded guilty to recruiting patients in exchange for illegal kickbacks as part a $205 million Medicare fraud scheme.

Former Network Resource Consultant Inc. chief Michael Mendoza pleaded guilty to health fraud conspiracy Thursday in Miami federal court.

Read More

Previous articleImage is Everything
Next articlePointing the Finger
Larry Benson
Larry Benson is currently the Director of Strategic Alliances for Revenue Discovery and Recovery at LexisNexis Risk Solutions. In this role, Benson is responsible for developing partnerships for the tax and revenue and child support enforcement verticals. He focuses on embedded companies that have a need for third-party analytics to enhance their current offerings.