Scattered Clouds70° FULL FORECASTScattered Clouds70° FULL FORECAST
Make us your home page
Instagram

WellCare whistle-blower talks about his corporate double life

Flying over Florida aboard WellCare's corporate jet, Sean J. Hellein feels queasy.

He's never been a good flier, but he's also nervous that his colleagues will notice the tiny videocamera on his shirt. The power pack and wires that FBI agents taped to his back and arms are scratchy and uncomfortable. He suddenly races to the back of the Learjet, throws up in the liquor cabinet, then returns. No one seems to notice.

Later, he's in a stall in the airport bathroom, wrestling to remove the electronic paraphernalia. His co-workers threaten to take off without him. They pester him, ask what's going on.

You have no idea, he thinks to himself.

Unbeknownst to anyone but his family, his lawyers and federal investigators, Hellein was in the midst of 18 months of undercover work. A senior financial analyst at WellCare, Hellein collected 1,000 hours of recordings, nearly wrecked his marriage and sometimes wondered if he would survive.

The wide-ranging fraud case he helped investigate would eventually deflate one of the highest-flying, fastest-growing companies in Florida.

• • •

Hellein, now 37, had a degree in finance from the University of Central Florida and five years experience at telecom and tech companies when he landed the job at WellCare in late 2002.

Though his starting pay at the insurer was just $35,000, Hellein quickly rose. His talent? Writing computer programs that could sift though mountains of claims data to identify the most expensive patients on WellCare's Medicare and Medicaid plans.

Hellein soon found himself part of a team of division chiefs who met monthly with Todd Farha, the chief executive who had led WellCare's acquisition by a New York investment group in mid 2002. Hellein's ability to home in on WellCare's medical spending, whether on transplants, premature babies or emergency room visits, complemented Farha's laser focus on cutting costs.

But Hellein said once the executive team got that information, they didn't do what most insurers do: have nurses work with members to improve care.

Instead, the focus was on forcing these patients off WellCare's rolls. When 425 premature babies were dropped in 2004, the nurses who handled the effort — calling parents and assuring them their babies would get better care elsewhere — were rewarded with a free dinner.

For the first few years, as his status ascended and his salary rose to $85,000, Hellein wasn't troubled by what the company was doing. Farha was a charismatic leader and Harvard MBA. It was smart business, not fraud.

"It was just numbers," Hellein said during an interview with the St. Petersburg Times last week. "You never see the people."

A comment in mid 2005 from a respected boss changed Hellein's mind. The man, who resigned soon after, put it bluntly: WellCare was stealing money from the state. Hellein realized he was right but had no idea what to do about it.

Hellein said WellCare had a "Trust Line" employees were supposed to call to report fraud. But it was widely believed that anyone who did so was quickly terminated. WellCare was so politically connected — the head of Florida Medicaid briefly served on its board and left with $1 million in stock — it seemed impossible to challenge. And Hellein said the culture of corruption was not only prevalent but key to advancement.

"WellCare was not like a couple of bad guys," he said. "There were 100-plus people working in corruption on a daily basis. The more fraud you did, the more bonuses you got, the more stock you got."

Hellein decided to act.

• • •

After getting a lawyer and agreeing to work with the FBI in August 2006, Hellein said, federal prosecutors gave him specific instructions: Just do your regular job, don't go looking for fraud, don't suggest anything illegal but if you're asked to implement a fraudulent plan, do it.

Hellein remained constantly on edge. His wife, busy with a career of her own and two little kids, thought he was nuts. Their marriage deteriorated to the point where every conversation turned into a fight.

With his home life a mess, Hellein threw himself into the challenge of being a double agent. He would be highlighting corporate documents for federal investigators until long after midnight. At 7 a.m. every morning, he'd be at the Starbucks at Waters Avenue and Anderson Road in Tampa. Instead of going inside for coffee, he'd park next to a tan sedan with heavily tinted windows. He'd hop inside and hand a female FBI agent his notes and recording devices, getting fresh equipment in return. Fifteen minutes later, with a lighter-sized recorder in his shirt pocket and sometimes a miniature camera on his shirt, Hellein would be on his way to WellCare.

During regular meetings with Farha and other top executives, Hellein could feel his heart racing as he tried to act normal while wired to the hilt.

"These guys are so bright, they watch everything and you don't want to miss a beat," he said. "You're trying to be a teammate at the same time you're not. But I got a great sense of pleasure because these were the brightest guys in the room and I was outsmarting them."

Hellein said if anyone suspected his covert activity, they never confronted him about it. Instead, his work was so valued his bosses gave him $300,000 worth of stock. FBI agents told him to keep it.

Hellein proved his value to the government when he videotaped a meeting of top executives in January 2007. Florida Medicaid officials had demanded an accounting of WellCare's behavioral health spending, and the company knew it was only about half of what the state believed. The solution: simply double every charge.

Hellein sat in swivel chair videotaping every speaker. "You had about 20 people talking about how to defraud the state," he said.

After the meeting, Hellein's boss, Peter Clay, chastised him for inviting so many people. "You have to be careful," Clay said. "This is fraud." Clay, who no longer works at WellCare, declined to comment.

Federal prosecutors refer to the tape as the "Golden Meeting."

• • •

As federal agents prepared to go public with their investigation, Hellein spent hours making notes on schematic drawings of WellCare's offices. He marked every room, showing who sat where, color coding the cubes to indicate what fraud they were involved in.

More than 200 federal and state agents raided the company on Oct. 24, 2007. Hellein watched the blue-jacketed agents swarm his workplace on TV at home; he'd quit with no notice.

A few people linked Hellein's sudden departure with the FBI's surprise appearance. They weren't happy. Angry callers threatened to punch him out for devastating their WellCare stock, which dropped 66 percent. One woman pounded on his door while he hid in a bedroom. A guy who refused to identify himself spent three days sitting in a truck at the end of Hellein's driveway.

"Everybody assured me there was nothing to worry about, but I had real concerns over my family's security," Hellein said. "I still worry."

Within weeks of leaving WellCare, Hellein and his family relocated to Atlanta, where he now works as a programmer with a nonprofit health insurer.

"My life came back to me once I was able to get out of WellCare," he said. "The place I work now is a breath of fresh air. They are good people."

• • •

Raised middle class, Hellein is on the verge of becoming a multimillionaire. The law allows whistle-blowers to share in up to 25 percent of any settlement. At least two other WellCare employees filed whistle-blower claims against the company, though Hellein was the first and the most deeply involved in the investigation. The Justice Department has tentatively agreed to settle these claims with WellCare for $137.5 million.

Hellein and his lawyer, Tampa's Barry Cohen, say that's inadequate punishment for a company they estimate stole $400 million to $600 million from government programs meant to care for the elderly and poor. They deny being driven by financial self-interest as they push for more money from WellCare, which had nearly $7 billion in revenue last year.

"It's already so much money it's ridiculous," said Hellein, who has promised to put half his payout into a foundation to care for sick kids. "I want to know what will it take for corrupt companies like this to stop. If a company can settle its fraud for one-quarter of what they stole, who's going to do this next?"

Reach Kris Hundley at khundley@sptimes.com or (727) 892-2996.

WellCare whistle-blower talks about his corporate double life 07/03/10 [Last modified: Monday, August 9, 2010 12:55pm]
Photo reprints | Article reprints

© 2014 Tampa Bay Times

    

Join the discussion: Click to view comments, add yours

Loading...