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State probe sought on WellCare

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By Jim Saunders and Carol Gentry
6/30/2010 © Health News Florida

Amid claims of widespread fraud by the state's largest Medicaid HMO, a state official has called on Attorney General Bill McCollum to prosecute WellCare Health Plan officials involved in trying to "rip off" the taxpayers.

The letter from Tom Arnold, Secretary of the Agency for Health Care Administration, specifically mentions the company's "cherry-picking" practice of dumping sick babies and dying patients from its membership rolls to boost profits.

Arnold also asked McCollum to prosecute officials of any other managed-care organizations that took part in schemes similar to WellCare, as described in the 2006 complaint by whistleblower Sean Hellein unsealed last week. However, Arnold's letter did not mention the South Broward Hospital District, which was accused of abetting WellCare in hiding money. 

The letter, which was dated Tuesday, came a day after Health News Florida published an article in which former AHCA Secretary Alan Levine described how WellCare officials lied to him and to legislators in order to get a boost in pay rates.

After reading the whistleblower complaint, Levine said, “If what I’m reading actually happened, there seemed to be an intent to mislead the state.

“With this information, I would certainly ask Medicaid Fraud Control (in the Attorney General’s Office) to look at prosecution,” said Levine, who now is Secretary of Health and Hospitals in Louisiana. “We have prosecuted providers for less than this.” 

While the U.S. Justice Department filed a felony charge of fraud against the company in May 2009, it has not brought criminal charges against any of the WellCare  officials accused of participating and directing the fraud.

Earlier this week, McCollum's office declined to comment about whether it was conducting further investigations of WellCare. It said it was reviewing the whistleblower complaint, which was part of a U.S. Justice Department case against WellCare. 

(Update: Sandi Copes, communications director for the Attorney General's Office, released this statement just after 2 p.m.: "Fighting health care fraud is one of the AG's top priorities, as indicated by the record recoveries the Medicaid Fraud Control Unit obtained last year ($203,966,340). Additionally, our criminal prosecutions continue to increase (108 in 2009). The criminal investigation into WellCare is ongoing, and our office is actively participating in that criminal investigation."

Hellein, a financial analyst for WellCare from 2002 to 2007, wore a wire for nearly 18 months and provided numerous internal documents to federal officials. The complaint was unsealed after WellCare announced last week that it had agreed to a preliminary settlement of $137.5 million with the U.S. Attorney's Office in Tampa. That proposed settlement of civil damages would be in addition to the $80 million the company agreed to pay to defer criminal charges. 

Two other whistleblower cases were unsealed this week, adding to the details about ways WellCare cheated Medicare and Medicaid programs, especially Florida's.

Arnold's letter focuses on two key allegations in Hellein's complaint. One involves WellCare's efforts to circumvent a requirement that it spend 80 percent of the money it received for mental-health programs on services to Medicaid beneficiaries.

"WellCare's officials spent substantially less than 80 percent on these services and then falsely characterized administrative expenses and profit as money spent on these services in their subsequent reporting to my agency,'' Arnold wrote.

The letter also calls attention to the company's alleged "cherry pick" to keep only healthy members. 

"If true," Arnold wrote, "this means that WellCare officials essentially dumped high-cost Medicaid recipients on our program's fee-for-service system, thereby costing the taxpayers substantial amounts of money.''

--Capital Bureau Chief Jim Saunders can be reached at 850-228-0963 or by e-mail . Carol Gentry, Editor, can be reached at 727-410-3266 or by e-mail.