WellCare says it's changed since $138M fraud settlement

WellCare is looking to submit a contracting bid with the Florida Medicaid program; however, its history of fraud is raising red flags for many stakeholders.

Florida is in the process of moving 1.2 million Medicaid members into health plans run by contracted private insurers, and Tampa-based WellCare is expected to win some of those contracts, the Miami Herald reported.

In April, WellCare reached a settlement with the Department of Justice over allegations that it overcharged Medicare and Medicaid by about $46 million. Although the Justice Department originally proposed the settlement in 2010, a whistleblower involved in the investigation didn't withdraw his objections to the settlement terms for two years. WellCare will make the $137.5 million fine and restitution payments over three years.

WellCare officials say the company has changed since that fraud settlement. "I think we have a highly competent and ethical group now running the company," former U.S. Sen. Bob Graham, who serves as a paid director on the company's board, told the Herald. "Our service will be our best evidence of our corporate integrity."

However, critics are concerned that since regulators were unable to discover Wellcare's previous fraudulent activities, they might miss them again. "The violations of WellCare were only made known because an employee from the inside told the story," Laura Goodhue, executive director of the health advocacy group Florida CHAIN, said. "How can the state make sure it doesn't happen again?"

If WellCare does win a Florida Medicaid contract, the state healthcare agency would be prepared to snuff out fraud. Michelle Dahnke, a spokeswoman with the state healthcare agency, told the Herald that the agency would inspect company offices, require insurers to report their finances and outline how they will prevent fraud.

To learn more:
- read the Miami Herald article

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