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Medicare Advantage Company Pays Over $20M to Settle False Diagnosis Allegations

December 6, 2010

America’s Health Choice Medical Plans, Inc. was a Medicare Advantage Organization. Medical Resources, LLC was its primary care provider. Both companies were owned and operated by Dr. Walter Janke and his wife, Lalita Janke. Now, the companies are out of business, and the Jankes are out $22.6 million. According to an announcement by DoJ late last month, the settled suit involved  “allegations that [the Jankes] caused Medicare to pay inflated amounts based upon the submission of false diagnosis codes.” Healthcare for chronic and severe medical conditions results in increased payments under Medicare regulations for Medicare Advantage Organizations. By fraudulently increasing the severity of a beneficiary’s diagnosis, a healthcare provider can raise the bottom line for the corresponding Medicare Advantage company. When both companies are owned and controlled by the same people, the potential for fraud is obvious.

To report Medicare fraud, contact Frohsin & Barger.

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