A 70-year old cardiologist, Dr. Walter Janke, and his wife, Lalita Janke, have agreed to pay $22.6 million to resolve Medicare fraud allegations – a stunning move that has analysts who follow events in the world of Los Angeles Medicare fraud talking.
The Jankes had owned two large organizations – Medicare Advantage and America’s Health Choice Medical Plans – and allegedly overstated patient diagnoses to garner extra money from the federal government. Lawyers for the U.S. in District Court argued that Jankes’ acts violated the False Claims Act. The U.S. has frozen $20 million of the Jankes’ assets. The settlement will be paid out of those assets as well as out of their personal funds.
The Centers for Medicaid and Medicare Services (CMS) has been engaged in a long and heated battle with the Jankes, according to an article in South Florida Business Journal. The cardiologist’s attorney lamented the situation: ”there has been a long history of clear animosity directed at the Janke’s from CMS.” The attorney argued that the Medicare audit done to determine the settlement amount was unfair – essentially, by extrapolating based on a fraction of a percentage of patient cases, CMS might have erred by as much as 30%.
But without wading too deep into the technicalities of the case, let’s bring it back and speak more generally about Southern California insurance fraud, white color crimes, and Medicare fraud. If you do as the Jankes allegedly did — bill for chiropractic, dental, or medical care that you didn’t provide — you can be charged with a crime. Other types of healthcare fraud include:
• Making up false medical records
• Billing twice for work
• Prescribing medications or therapies that are clinically unnecessary
• Billing non-emergency services at an emergency rate
• Requesting meaningless or unnecessary tests
• Otherwise violating laws, such as Insurance Code Section 1871.4, Penal Code Section 118, or Penal Code Section 550
If you are convicted of defrauding Medicare or an insurance company or Medi-Cal, you can face jail time, serious court costs and fines, loss of your medical license, and forced restitution to victims, including insurance carriers and the state.
If you or a loved has been hit with a charge of Southern California white collar crime, look to Los Angeles criminal defense attorney Michael Kraut for solid, reliable advice. Attorney Kraut was a prosecutor for many years – and he also has a Harvard Law School education. He can discuss your matter in confidence today and provide high caliber strategic advice about how to protect your reputation, assets, and license to practice.