WellCare is a huge healthcare company serving almost 2.5 million patients in the United States. Headquartered in Tampa, the company is no stranger to litigation. Although any company of that size is likely to be sued, WellCare was wracked by several false claims act (whistleblower) cases that exceeded $1 billion in alleged losses. That kind of litigation is big for any size company.
According to a press release issued by the company, WellCare finally resolved several false claims cases that were pending in federal courts in Florida and Connecticut. The cases were tentatively settled a year ago after the company agreed to pay $137 million and enter into a corporate integrity agreement. The settlement figure might have been higher, however the government believed the company couldn’t afford more.
Three of the four whistleblowers agreed to the settlement. In a rare move, the fourth objected. Although the law allows a whistleblower (called a “relator”) to object, the final say rests with the court. Usually the court adopts the government’s finding and recommendations. After months of legal wrangling, the sole objector apparently agreed to withdraw the objection.
The WellCare false claims cases are typical of many health care fraud cases, although much larger.
In this case, the whistleblowers alleged the company used creative accounting in order to manipulate the amount of premiums set by the government for Medicare and Medicaid recipients. They say the company also upcoded services to earn more money, billed for services rendered to patients that were already deceased, “dumped” certain sick patients, dumped providers that would not do as the company wanted, paid kickbacks and misrepresented credentials of service providers.
Another case claimed that WellCare failed to use licensed nurses to provide required eligibility screening.
Things looked especially bleak for the company for quite some time. Shortly after the first false claims act case was filed, the company announced in a regulatory filing with the SEC that its headquarters had been raided by law enforcement. During that same time, the company also announced that the SEC and Connecticut Attorney General’s Office were investigating the company. Those matters are now closed.
The settlement allows the company to continue providing services under the Medicare and Medicaid programs.
Like most major health care fraud cases, the WellCare cases were successful because concerned employees and insiders came forward. The allegations against the company not only impacted on taxpayers (Medicare is a federally funded program) but involved patient health and safety as well.
Upcharging and billing for services to dead people is bad enough but using unqualified people to perform evaluations is dangerous. (In another recent case a hospital group was accused of performing unnecessary cardiac surgeries simply to make a profit.)
Obviously, Medicare and insurance fraud is illegal. Contrary to popular perception, however, the crime is anything but victimless. Many state have waiting lists for health care assistance and everyone suffers when premiums increase. When costs go up, people can’t afford coverage or must wait. Whistleblowers that won’t stand still for such abuses are the true heroes in the fight against healthcare fraud.
Many people come forward simply to do the right thing. Others do so in part because the government will pay up to 30% of what is collected based on their information. To take advantage of the program, the whistleblower can bring a lawsuit in the name of the government against the people or organization committing the fraud.
About our firm. MahanyLaw is a full service boutique law firm that concentrates in combatting fraud anywhere it may be found. Healthcare, mortgage fraud, Ponzi schemes, phony welfare benefit plans and investment frauds – we are here to help victims get back their hard earned money. Presently we are prosecuting the largest false claims case against a mortgage lender in the U.S. – HUD’s $2.4 billion claim against Allied Home Mortgage. We proudly represents whistleblowers and welcomes comments and questions – For more information, contact attorney Brian Mahany at (direct) or by email at . All inquiries are kept in strict confidence.
MahanyLaw – America’s Fraud Lawyers. Offices in Milwaukee, Wisconsin; Detroit, Michigan, Portland, Maine & Minneapolis, Minnesota. Services available in most jurisdictions.