Michelle Dahnke, a spokeswoman with the Agency for Health Care Administration, said the administration has ramped up its oversight, requiring health plans to report their finances and outline how they will prevent fraud, among other measures.
State law also requires that if a company stops providing service in one area, it must forfeit all of its other contracts. It would then pay a penalty plus the cost to transfer affected patients to another plan.
Tom Arnold, a healthcare lobbyist and head of the Medicaid program from 2004 to 2007, said the state can access historical records on health plans and can get more information as needed.
“I don’t think anyone has a reason to believe [WellCare] or any other entity in the state is doing anything inappropriate,” he said. “I don’t mean nothing bad will ever happen again, but the state has very strong tools to measure the appropriateness of care.”
But Sean Hellein, the WellCare financial analyst who blew the whistle on the company’s fraudulent bookkeeping in 2007, said the company previously had no problem evading the state’s effort to audit its activities. During one on-site visit by state officials, Hellein said, “The idea was that as long as we could keep them in the dark, everything would be perfect.” If a particularly smart state worker started asking too many questions, Hellein said, WellCare had a remedy: It would simply hire the person away from the state at a much higher salary.
The strategy worked. It took the agency several years to catch on to the company’s strategy of double-billing the state for patient services.
As Florida moves to Medicaid managed care, WellCare now has several advantages in the bidding process.
It is one of the few companies that specializes in covering Medicaid and Medicare patients, and serves 400,000 Medicaid patients who have already opted for managed care. The company and its executives also have contributed at least $2 million to state political campaigns since 1997.
And the 2011 law that mandated the Medicaid changes also gives preference to Florida-based companies — and that includes WellCare.
Tampa Bay Times staff writer Kris Hundley contributed to this report. Brittany Alana Davis can be reached at email@example.com.