WellCare charged with fraud (Florida's largest Medicaid HMO contractor)

[seafan]

Source: Florida Health News

WellCare Health Plans Inc., Florida's largest Medicaid HMO contractor, was charged with felony health fraud Tuesday and has agreed to pay $80 million to defer prosecution, U.S. Attorney A. Brian Albritton announced. His office will appoint a monitor to keep an eye on the company's compliance with the law for 18 months.

The Tampa company used a subsidiary to hide $40 million that belonged to Florida Medicaid and Florida Healthy Kids, he said, and was supposed to have been spent on mental-health and substance-abuse treatment. The other $40 million that WellCare will have to pay is called a "civil forfeiture" -- essentially, punishment.

The fraud was carried out by personnel who are no longer with the company, he said. No individuals were named, but he said the investigation is continuing and did not rule out the possibility of high-level individual indictments later on.
The charges and agreement for deferred prosecution -- an alternative to criminal indictment -- were filed with U.S. District Court in Tampa on Tuesday morning, just before Albritton appeared at a press conference for the announcement.
Albritton attributed the motive to "greed, the desire for more profit." He declined to say how high in the company the knowledge of the fraud went.

The top three executives at WellCare at the time the investigation began two years ago all resigned in early 2008, shortly after it became public: President, CEO and Chairman Todd Farha, CFO Paul Behrens and General Counsel Thaddeus Bereday. ..... (Assistant U.S. Attorney) Trezevant said WellCare used a "phantom" subsidiary, Harmony Behavioral Health, to hide the fact that the company's Medicaid HMOs, HealthEase and StayWell, weren't spending as much money as they were supposed to on patients' treatment. Under the terms of their contracts with Medicaid and Florida Healthy Kids Corp., the HMOs were supposed to pay the unspent money back.

"Harmony was created to disguise what they actually spent," Trezevant said.


Read more: http://www.floridahealthnews.org/index.cfm/go/public.st...

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Interesting how WellCare made out like bandits during the period of time Jeb Bush was pushing to *reform* Medicaid in Florida, forcing patients out of traditional Medicaid and into HMOs.



Also interesting is that Well Care is aiming for 'deferred prosecution -- an alternative to criminal indictment'. This is an investigation that needs more exposure to capture all of the rats, particularly any high-ranking political figures.