Thanks to a whistleblower and the court that unsealed his complaint, we can now see what really goes on when a large corporation decides to defraud the government. Of course it really is defrauding all of us.
In this case, WellCare Health Plans, which was Florida’s largest Medicaid HMO contractor, played loose and fast with the rules. A complaint has been filed by former WellCare financial analyst, Sean J. Hellein, reports Health News Florida. His complaint has launched a federal investigation and the records have now been unsealed.
WellCare was found to dump hundreds of sick and terminally ill patients and newborns from its rolls to increase profits by millions. WellCare reportedly stole between $400 million and $600 million from Medicare and Medicaid program, in several states besides Florida. The company in the past has called its financial dealings “accounting errors.”
Hellein’s attorney, Barry Cohen of Tampa, persuaded U.S. District Court Judge James. S. Moody to unseal the records on Thursday, June, 24, after it was reported that WellCare was discussing settlements with the U.S. Attorney’s Office for $137.5 million. Apparently crime pays.
Florida’s Attorney General, Bill McCollum, a Republican running for governor, is calling for a full repayment plus damages.
Some other items attributed to WellCare include:
- Moving money between accounts to up the cost of healthcare in some cases paying for a treatment years in advance to make it look more costly that resulted in an increase in Medicaid premiums.
- Failing to reimburse overpayment errors to the tune of millions.
- Fraudulently putting additional expenses into the Healthy Kids program in Florida.
- WellCare cherry-picked the healthiest members dis-enrolling the sick. Eliminating a sick baby from coverage could save the company about $20,000. A terminally ill person saved the company more than $11,000.
One WellCare employee aware of the fraudulent activities, Gregory West, pled guilty in December 2007 but has still not been sentenced. Three company executives have not been charged. WellCare moved out of Duval and Broward counties last year. Before that almost a quarter of its membership was from Florida.
