WellCare: Free at last?
(Excerpt)
"When the Hellein lawsuit was unsealed in June 2010, as HNF reported , it described financial corruption that went far beyond the top executives. It alleged:
--WellCare conducted a study to figure out which Medicaid recipients were profitable and which were not so that it could engage in ``cherry-picking,'' a term for enrolling only the profitable members. The study found that disenrolling a baby born with health problems saved the company an average of $20,000; each terminally ill patient saved $11,500.
Those who were persuaded to resign from WellCare went into the general Medicaid or Medicare fee-for-service programs. The employees who pulled that off got bonuses, according to Hellein.
--WellCare moved money between accounts to make it appear that patients' treatment cost much more than it actually did. In some cases, the company made payments years in advance to jack up the apparent cost of care to fool states into increasing Medicaid premiums. .
-- When states made overpayment errors, WellCare didn't pay the money back, as its contract requires. Florida Medicaid made a series of overpayment blunders that fattened WellCare's bottom line by many millions; those who made the errors included both state officials and contractors.
--Sometimes hospitals and physician groups helped WellCare hide its true spending from Medicaid programs by accepting payments through one account for expenses incurred by another. Sometimes they allowed WellCare to pay for future years' expenses to make it appear spending for the current year was higher than it actually was."
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