Tuesday, May 05, 2009


WellCare, one of Hawaii’s QexA providers, escapes criminal charges by paying $80 million in Florida

by Larry Geller

A Jacksonville Business Journal article, WellCare to pay $80 million to Florida Medicaid, Healthy Kids (5/5/2009), provided details of the settlement in Florida with WellCare, which operates health plans for governments in several states. In Hawaii the company is one of two Mainland firms contracted by the Lingle Administration to run Quest Expanded Access (QexA) Medicaid program. The Hawaii subsidiary is called Ohana Health Plan.

What was the issue in Florida?

WellCare was accused of falsely and fraudulently inflating expenditure information it submitted to Florida Medicaid and Healthy Kids programs from mid-2002 through 2006.

According to a court filing, WellCare kept for itself money it received from the Florida health care programs that was supposed to be used to provide medical services. The filing said WellCare set up a wholly owned entity, Harmony Behavioral Health Inc., through which it funneled state funds.

WellCare then fraudulently reported money that went to Harmony as expenditures on service, the filing said.

FBI Special Agent in Charge Steven Ibison blamed “corporate greed” in a statement included in the release.

Hawaii’s Department of Human Services has come under criticism by seniors advocates for awarding contracts to the out-of-state for-profit companies instead of to Hawaii-based non-profits. An informational session was held earlier this year at the legislature by Sen. Suzanne Chun Oakland that was heavily attended and which highlighted several problems in the transition to the new scheme.

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