Whistleblower complaints about WellCare operations unsealed in Florida

Jul 1 2010

The St. Petersburg-Times: Three complaints by whistleblowers suing WellCare Health Plans Inc. have been unsealed in recent days as part of a federal probe into the company's operations. Federal officials raided the company offices in 2007. In the most recent complaints, "Clark J. Bolton, a former supervisor of special investigations at WellCare, said the insurer encouraged overbilling and refused to audit claims for fraud in order to curry favor with doctors and hospitals and build market share. The result was millions in excessive and illegal expenses passed through to federal Medicare and state Medicaid programs, Bolton said. Eugene Gonzalez, a referral coordinator for seven years, claimed WellCare met government customer service standards only because it had employees create backdated documents and make bogus calls to the company's phone lines. Failure to meet these standards would have resulted in the loss of billions of dollars worth of Medicare and Medicaid contracts."

A complaint by another employee, Sean Hellein, who has cooperated with federal authorities, was unsealed last week and alleged that the company "hid profits in an offshore subsidiary, dropped coverage of premature babies and terminally ill patients to cut costs and kept millions in unearned Medicaid payments." The company has declined to comment on the lawsuits by former employees but the "government and WellCare have tentatively agreed to settle all whistle-blower claims for $137.5 million" (Hundley, 6/30).

Florida Health News: Hellein's attorney "persuaded U.S. District Court Judge James S. Moody to unseal the records on Thursday after learning that the U.S. Attorney's Office was discussing settling the case with WellCare for $137.5 million. In telephone interviews, Cohen said he hoped that the U.S. Attorney General and Florida Attorney General Bill McCollum will read the complaint and 'raise hell' with the U.S. Attorney's Office in Tampa for not insisting on full repayment plus damages. 'The state of Florida got screwed out of $300 million, probably more than that, to say nothing of triple damages' that can be awarded in such cases under the law, Cohen said" (Gentry and Wells, 6/29).