|
Attorney
General Mike DeWine...
DeWine
announces Medicaid Fraud Settlement of $2.2 Million
(COLUMBUS, Ohio) -- Attorney General Mike DeWine announced today that
Ohio, eight other states, and the federal government have settled
allegations against WellCare, a health maintenance organization (HMO)
that had entered into contracts with various States’ Medicaid programs
to provide managed care services to enrolled program
beneficiaries.
“Medicaid dollars are to be used for the health care of those in need,
not to be manipulated for profits,” said Attorney General DeWine. “The
funds Ohio gets in this agreement will be used as they should, for the
care of people’s health.”
Under the Agreement, Ohio’s federal and state share is $5.6 million,
with $2.2 million going directly to Ohio. Medicaid is funded jointly by
the federal and state governments. WellCare agreed to pay the
participating States and the United States $137.5 million, plus
interest, in four installments over three years. This settlement
resolves allegations of accounting fraud, falsification of records and
other reports, including number manipulation, and manipulation of the
enrollment of covered recipients by selective marketing and related
misconduct.
Examples of the alleged accounting fraud include improper acts such as
inflating expenses that serve as the basis for setting capitated rates
– in one allegation, counting reinsurance profit as an expense.
Examples of alleged falsification of records and manipulation of
numbers include falsifying encounter data, and manipulating actuarial
estimates of claims not yet reported or paid and the percentage of
every premium dollar spent directly on the provision of health care.
Examples of alleged manipulation of the enrollment of covered
recipients include targeting low-cost, healthy persons for enrollment,
while discouraging, failing to enroll, or disenrolling high-cost,
chronically ill persons.
As part of the settlement, WellCare has also entered into a Corporate
Integrity Agreement with the Office of Inspector General of the
Department of Health and Human Services. This Agreement provides for
on-going oversight of the corporation’s rehabilitation for three years.
The investigation involved five whistleblower lawsuits filed under
provisions of the Federal and certain State False Claims Acts. These
actions are pending in the United States District Court for the
District of Connecticut, the Middle District of Florida and the State
of Florida Second Circuit.
A National Association of Medicaid Fraud Control Unit Team representing
the affected States participated in the investigation and conducted
settlement negotiations with WellCare on behalf of the settling States.
Team members included representatives from Ohio, Florida, Illinois,
Indiana, and New York.
|
|
|
|
