Doctor Sentenced in Multi-Million Dollar Health Care Fraud and Money Laundering Scheme Involving Sober Homes and Alcohol and Drug Addiction Treatment Centers

On November 9, 2017, the U.S. Attorney’s Office, Southern District of Florida, announced that Doctor Joaquin Mendez was sentenced to 48 months in prison, one year of supervised release, and ordered to pay $2,198,520 in restitution for his participation in a multi-million dollar health care fraud and money laundering scheme that affected Amtrak’s employee health plan.

Our office is participating in a series of complex insurance fraud investigations with the Greater Palm Beach Health Care Fraud Task Force (Task Force), combatting crimes related to fraud within “sober homes” and the opioid crisis in South Florida. These sober homes were purportedly in the business of providing safe and drug-free residences for individuals suffering from drug and alcohol addiction. However, these investigations revealed that the individuals who established these sober homes conspired with others, including Mendez, to obtain patients—including dependent children of Amtrak employees—who would receive ineffective and medically unnecessary substance abuse treatment and testing.

The investigation determined that Mendez served as a medical director of one of the illicit treatment centers. Instead of properly using his medical expertise to evaluate patient treatment, Mendez participated in a bribe and kickback scheme that resulted in fraudulent lab tests and related insurance billings. Mendez facilitated illicit lab tests by signing doctor’s orders for urine tests and saliva drug tests for patients he had never seen or examined. Mendez admitted that he knew his actions would result in fraudulent insurance billings, and that when he did see patients, he used billing codes that reflected more complex and lengthier examinations than he actually performed.