Corporate Compliance

Florida-based Medicare Advantage plan owners and provider agree to $22.6 million settlement

Compliance Monitor, December 1, 2010

Walter Janke, MD, his wife, Lalita Janke, and Medical Resources LLC agreed to pay $22.6 million to resolve allegations that they submitted false diagnosis codes, according to a Department of Justice press release.

The Jankes owned and operated America’s Health Choice Medical Plans Inc. (AHC), a Medicare Advantage organization. They also owned Medical Resources, which was AHC’s primary care provider.

The Jankes allegedly violated the False Claims Act by causing AHC to falsely increase the severity of beneficiary diagnoses to obtain higher Medicare payments. Medicare Advantage organizations are paid more to provide services for members with serious and/or chronic medical conditions then they are for relatively healthy members.

The settlement is part of the government's Health Care Fraud Prevention and Enforcement Action Team, which was created in May 2009.

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