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.stories/article/11911

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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.

[kestrel91316]

1. Do corporate parasites ever FAIL to defraud taxpayers, given the

slightest opportunity??

Enquiring minds want to know.

[Dappleganger]

2. Now there's a surprise.

When in doubt of the republicans' innate ability to completely screw over people and their economy, look at Florida.

[vinylsolution]

3. And there was Jeb Bush....

... at that townhall event just the other day, 'positioning' himself as a leader of the GOP.

Over the cliff they go, singing and cheering all the way....

[peace frog]

12. ...as we applaud their descent

Hey GOPers, they say it's not the fall, it's the abrupt landing that hurts. :evilgrin:

[bobthedrummer]

4. Bush/Cheney administration criminal Tommy Thompson appointed Ruben Jose King-Shaw Jr.

Deputy Director of Centers for Medicare/Medicaid Services/CMS in May 2001. King-Shaw jr was one of Well Care's main executives-both Tommy Thompson and Ruben Jose King-Shaw Jr. are still free.

"Another BFEE undertaking-privatized cradle to grave 'healthcare'" (archived post from 1-7-08 or see posts #55&57 if not centered by hyperlink)
http://www.democraticunderground.com/discuss/duboard.php?az=view_all&address=389x2596898#2619628

[Bread and Circus]

5. Both companies (Health Plan of Michigan and Great Lakes Health Plan) that do Medicaid in Michigan...

are corrupt as well as far as I am concerned. A bunch of cheating, lying fuckers run these HMO's. Get private insurers out of administering medicaid and medicare altogether.

[Hannah Bell]

6. couple of websites out there have been talking about wellcare's corruption since forever.

[fasttense]

7. This is why any national medical solution that includes health Insurance companies

will be way more expensive to administer than any single payer plan. Not only do patients have to pay for huge CEO payouts, and huge profits for uber wealthy stock holders but we will have to pay for all their fraud too.

Health Insurance Corporations are just one huge fraud.

[seafan]

9. ConservaDem Ben Nelson: 'A public plan would hurt the private insurance plans.'

But yet....

(ConservaDem Senator Ben) Nelson’s problem, he told CQ, is that the public plan would be too attractive and would hurt the private insurance plans. “At the end of the day, the public plan wins the game,” Nelson said. Including a public option in a health plan, he said, was a “deal breaker.”

Think Progress, May 2, 2009


For ConservaDems like Ben Nelson, any action taken that would lead to revolutionizing people's health care into a single payer, national model is *a deal breaker*.



(Yet, he probably enjoys his over-65 single payer coverage called Medicare...)


People like this are rat ba$tard$.

[Donnachaidh]

8. Is this the same company handling schip in Georgia?

I know it's kind of a dumb question. But I wouldn't be surprised. I wonder if any of the folks in Georgia will start looking into their dealings here. Or perhaps Wellcare has greased the right amount of palms to keep the good old boys happy...

[Dr.Phool]

10. They were my biggest customer, when I had a restaurant in Tampa.

Lunch deliveries to them were almost enough to support the business.

[Occulus]

11. I WISH **I** COULD PAY MONEY TO "DEFER PROSECUTION"!!!

Sorry to shout, but damn. Come right out and say it, why don't they....

[quidam56]

13. Fraud & Health Care ? Surely not...

http://www.wisecountyissues.com

We need a cure for health care in America, Profit Care comes ahead of Patient Care !

[bobthedrummer]

14. kick

[rms013]

15. Cost of doing business

It amazes me when these companies get fined and no one thinks anything about where they get , in this case, $80.000.000.00 to pay off the government. Other companies are coming up with hundreds of millions. There is no real restriction on the company, it becomes just the cost of doing business. Enough is enough. When they screw the taxpayer and the people who are supposed to be recieving services I think it constitutes treason. If corporations are to be given the right of individuals than they should be held accountable as individuals.

[bobthedrummer]

16. kick