Walter Janke, MD, his wife Lalita, owners of Vero Beach, FL-based Medical Resources LLC, will pay $22.6 million to resolve allegations that they filed false diagnostic codes to inflate Medicare reimbursements, the Justice Department has announced.
The Jankes were the owners of America's Health Choice Medical Plans Inc., a Medicare Advantage Organization, for Medicare beneficiaries. The Jankes also owned Medical Resources, AHC's primary care provider. AHC and MR are now defunct.
The agreement resolves a lawsuit brought by DOJ alleging that the Jankes and MR violated the False Claims Act by causing AHC to falsely increase the severity of diagnoses to get higher Medicare payments.
A federal district court judge in Miami also froze approximately $20 million of the Janke's assets believed to have been generated by the unlawful scheme. The assets and money from the dissolution of AHC are being held in receivership by the Florida Department of Financial Services, and will be used to pay the settlement.
"Patients seeking healthcare should be able to rely on the diagnoses they are given," said Tony West, Assistant Attorney General for the Justice Department's Civil Division. "We will aggressively pursue those who falsify medical diagnoses in order to receive taxpayer funds to which they are not entitled."
John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.