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Sunday, July 18, 2010
$400M Medicare/Medicaid scam run by parent of Ohana Health Plan
By Andrew Walden @ 12:55 PM :: 8698 Views :: Health Care

Here are some pieces of a story which as not been told in Hawaii…

LINK>>Whistleblower complaint full text  (Hawaii pops up on page 2)

LINK>>>Health News Florida WellCare coverage 

PBN: Alleged health-care scam reached Hawaii shores: Hawaii among seven states named in complaint against WellCare

(PBN’s use of “Alleged” is incorrect.  WellCare has already admitted to the scam.  This case was initiated in 2007, but the whistleblower report was kept sealed until now.)

A recently unsealed whistleblower complaint against WellCare Health Plans names Hawaii as one of seven states defrauded of an estimated $400 million to $600 million in taxpayer funds.

It is not clear to what extent Hawaii residents may have been defrauded.

WellCare is the parent company of Ohana Health Plan, which manages Medicaid benefits for Hawaii’s aged, blind and disabled residents and the dual eligible population — those enrolled in Medicaid and Medicare. (These are the target populations served by Ohana Health Plan in Hawaii.)

read more


Chicago Tribune: Judge unseals whistle-blower complaint on WellCare Health Plans


WellCare also restructured its benefit package to discourage the least-profitable Medicaid recipients from enrolling and encouraging those who were more profitable to sign up.

Low-income mothers and children yielded a net of only about 10 percent, while the physically and mentally disabled paid for by Medicare yielded a net of 30 percent, the complaint says. (Those are the same target populations served by Ohana Health Plan.)

The company said it expected to settle the civil damages case for $137.5 million. That is in addition to $80 million WellCare agreed to pay in May 2009 to defer criminal prosecution on a felony charge of fraud. About half of that money went back to Florida health programs.

Hellein's complaint names other states besides Florida as victims of WellCare's fraudulent accounting — Illinois, Indiana, Louisiana, New York, Georgia and Hawaii.

And it names other Medicaid HMO companies as participating in some of the same inappropriate accounting practices, particularly failing to give back overpayments made in error.

Hellein's complaint, which was filed June 7, 2006, has been kept sealed since then at the request of the Justice Department. Between his complaint and the FBI raid in October 2007, Hellein worked undercover, providing more than 1,000 hours of surveillance audio and video, Cohen said.


WellCare Announces Resolution to Government Investigation

WellCare Health Plans, Inc. announced May 5, 2009 that it has resolved investigations by the United State’s Attorney’s Office for the Middle District of Florida and the Florida Attorney General’s Office by entering in to a Deferred Prosecution Agreement (DPA). A copy of the DPA and Information can be found at the links below:
Deferred Prosecution Agreement with Exhibit


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