Source: ModernHealthcare.com
The Florida secretary of healthcare administration is urging state officials to investigate and attempt to prosecute officials at WellCare, one of the state's largest private managed-care providers.
The letter from state Agency for Health Care Administration Secretary Thomas Arnold to Attorney General Bill McCollum comes after a federal judge unsealed a whistle-blower complaint by a former WellCare analyst who accused the company of conspiring to “rip off” the state's Medicaid program, Arnold's letter says.
The complaint, filed four years ago in U.S. District Court for the Middle District of Florida by former WellCare employee Sean Hellein, alleges that WellCare conspired with at least two hospital systems to falsely characterize the nature of certain payments to make it appear that the firm was spending less on administrative overhead than it was.State law imposed penalties if spending on actual care was less than 80% of the funds.
Arnold's letter also highlighted Hellein's allegations that WellCare would “cherry pick” profitable patients with less complex illnesses while encouraging high-cost patients to go onto Medicaid's fee-for-service system.
WellCare has entered a deferred-prosecution agreement with McCollum's office that requires a payment of at least $80 million. A spokeswoman for McCollum's office said in an email that the criminal investigation into WellCare is ongoing. The U.S. attorney's office in Tampa, Fla., filed a request this week to join Hellein's lawsuit against WellCare, three former WellCare executives, and two other Florida managed-care providers. The government's complaint in that case is expected to be filed shortly.