Make us your home page
Instagram

More lawsuits against Tampa company WellCare made public

The allegations of wrongdoing at WellCare Health Plans Inc. continued Tuesday with the unsealing of two more whistle-blower complaints against the Tampa company.

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.

These complaints bring to three the number of whistle-blower lawsuits that have been made public in the federal investigation into WellCare, which began with a high-profile raid by FBI agents in October 2007.

WellCare has declined to comment on the lawsuits by former employees, parts of which are still sealed. Amy Knapp, a company spokeswoman, said, "The company has not obtained any documents or information which the whistle-blowers believe support their claims. It would be inappropriate to comment further."

Bolton and Gonzalez filed their complaints in late 2007 and early 2008, respectively. That was well after Sean J. Hellein, a senior financial analyst at WellCare, approached investigators in 2006 about what he saw as pervasive fraud in the organization.

Hellein, whose lawsuit was unsealed last week, worked undercover for federal agents for 18 months gathering evidence. His complaint alleges that WellCare 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. Total costs to government programs was $400 to $600 million, Hellein estimates.

The government and WellCare have tentatively agreed to settle all whistle-blower claims for $137.5 million, but Hellein's attorney, Barry Cohen, said he intends to fight for more.

"If you only have to pay back half of what you steal, it's not a deterrent to health care fraud," he said.

U.S. Rep. Kathy Castor criticized the proposed settlement as wholly inadequate in a letter this week to Attorney General Eric Holder. "Where is the penalty and punishment for such egregious actions?" she wrote. "It appears that companies such as these simply build such payments into the 'cost of doing business.' We cannot allow this to continue."

While the estimates of damage were smaller in the two later whistle-blower complaints, they complement Hellein's depiction of a corporate culture that pushed the ethical envelope on every level. To make it appear that doctors were getting their calls answered quickly, employees were ordered to make quick "line checks" to boost the averages, Gonzalez claimed. When members appealed a rejected claim, the company gained more time to respond by simply putting a fake "receipt date" on the file, according to his lawsuit.

Bolton said he was fired after one year of heading WellCare's special investigation unit because he complained internally about fraudulent practices. He said an after-hours pediatric clinic was allowed to overbill for office visits because WellCare wanted to keep the contract and it meant higher reimbursements from Medicaid.

Although his department had software that could check hospital claims for fraud, Bolton said he was instructed not to use it for fear of alienating the customer. WellCare also refused to audit claims from Medicare's private-fee-for-service plans, he said, resulting in a potential $100 million in unrecovered fraud. In several cases in which WellCare investigated overbilling in response to a complaint, Bolton said, the company kept the settlement instead of returning it to the government as required.

Though Bolton, who lives in Safety Harbor, has been waiting for nearly three years for resolution of his case, his attorney, John Newcomer, expressed support for the proposed settlement.

"Everyone has done a great job and worked very hard to get to the resolution we've gotten," he said. "For the civil case to take this amount of time is not at all unusual."

Kris Hundley can be reached at khundley@sptimes.com or (727) 892-2996.

More lawsuits against Tampa company WellCare made public 06/29/10 [Last modified: Tuesday, June 29, 2010 9:30pm]
Photo reprints | Article reprints

© 2017 Tampa Bay Times

    

Join the discussion: Click to view comments, add yours

Loading...
  1. UPS relocates express operations from St. Pete-Clearwater to TIA

    Airlines

    TAMPA — United Parcel Service Inc. is switching airports for its express air operations. Beginning in October, UPS will relocate from St. Pete-Clearwater International Airport to Tampa International Airport.

    Beginning in October, UPS will move from St. Pete-Clearwater International Airport to Tampa International Airport. [Associated Press file photo]

  2. Richard Corcoran takes aim at public financing of campaigns

    State Roundup

    TALLAHASSEE — House Speaker Richard Corcoran, R-Land O'Lakes, may not be running for governor — not yet anyway — but his latest idea will get the attention of those who are.

    House Speaker Richard Corcoran wants the Constitu?tion Revision Commis?sion to ask voters to repeal the state’s system of partial financing of statewide elections.
  3. Related Group breaks ground on complex at old Tampa Tribune site

    Real Estate

    TAMPA — When Miami developer Jorge Perez first eyed a 4.2-acre tract on the west bank of the Hillsborough River two years ago, people asked him if he wouldn't prefer to build on the opposite side closer to the downtown core.

    No way.

    From left, Related Group executive associate Arturo Penaa, Jorge Perez, center, founder and CEO of the Related Group, Mayor Bob Buckhorn and Steve Patterson, the President of Related Development dig their shovels  during the groundbreaking ceremony of the 400 unit Riverwalk Manor apartment complex on site of the old Tampa Tribune building on Wednesday. [OCTAVIO JONES | Times]
  4. Eat 3-course meals for $35 at these 100 restaurants for Orlando's Magical Dining Month

    Food & Dining

    In the early 1900s, hotels offered "table d'hote" or "prix fixe" menus as a form of loss leader. Hotels didn't necessarily make money on these lower-priced, multi-course meals, often served at communal tables, but they made up for it on the booze. Prohibition may have contributed to a gradual shift toward a la carte …

    Bulla Gastrobar serves a variety of Spanish and Portuguese dishes.
  5. Plant City farmer hopes robot pickers can save strawberry industry from shrinking labor force

    Agriculture

    PLANT CITY — If current trends continue, the region's status as a major strawberry producer will depend in large part on what happens in Mexico.

    Strawberry pickers work during the daytime, when fruit is more likely to bruise. Machine pickers can work at night. The owner of Wish Farms in Plant City is developing automated pickers and hopes to see them at work on a widespread basis in five years. [Times file]