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Florida Medical Practice pays millions to settle False Claims suit

Florida Medical Practice pays millions to settle False Claims suit

 

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Medical Resources LLC, a Vero Beach, FL based medical center has agreed to pay $22.6 million to settle a False Claims Act suit that alleges the filing of false diagnostic codes in order to inflate Medicare reimbursements according to the Department of Justice.

Medical Resources is owned and operated by Dr Walter and Lalita Janke. The Jankes also own American Health Choice Plans, Inc., the parent company that operates Medical Resources as it’s primary care provider. Both of the operations are now defunct.

Specifically, the severity of Medicare beneficiaries medical conditions were inflated so that more money could be recouped which lead to a False Claims Act suit. The two companies were founded in 2000. The Jankes conglomerate was a Medicare Advantage Organization (MAO). MAO’s will pay out more money for patients with serious or chronic medical conditions.

Besides suing the Jankes and Medical Resources the DOJ was also successful in convincing the court to freeze $20 million in assets which will be used to help pay the settlement. The rest of the payment will come from the dissolution of the two companies the Jankes used to own. Those funds are in a receivership held by the Florida Department of Financial Services.

Stated Tony West, Assistant Attorney General for the Justice Department’s Civil Division, “Patients seeking health care should be able to rely on the diagnoses they are given. We will aggressively pursue those who falsify medical diagnoses in order to receive taxpayer funds to which they are not entitled.”

This is another battle won in the fight to combat health care fraud. The False Claims Act has allowed the federal government to reclaim over $4.2 billion since January 2009 in cases involving fraud against federal health care programs. While no estimate has been released, it is believed that a substantial portion of that sum has been paid to whistleblowers.

 

Sources:

http://www.tcpalm.com/news/2010/nov/24/vero-beach-doctor-wife-agree-to-226-million-for/

http://www.bizjournals.com/southflorida/news/2010/11/24/doctor-wife-to-pay-226m-for.html

http://www.businessweek.com/ap/financialnews/D9JMOA0O0.htm

http://www.thecypresstimes.com/article/News/National_News/FLORIDABASED_MEDICARE_ADVANTAGE_PLAN_OWNERS_PRIMARY_CARE_PROVIDER_AGREE_TO_PAY_226_MILLION_TO_SETTLE_CLAIMS_OF_FALSIFYING_DIAGNOSES/36714

http://www.healthleadersmedia.com/content/COM-259452/Florida-Physician-to-Pay-226M-to-Settle-Medicare-Fraud-Claims##

 
 
 

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