Florida health programs for poor may get $45M from WellCare
By Carol Gentry
7/29/2008 Florida Health News
If an Illinois audit is correct, Florida could receive more than $45 million in repayments from WellCare Health Plans. A week ago, WellCare released documents admitting that it failed to repay $46.5 million to two states, Florida and Illinois. On Monday, a spokeswoman for Illinois' Medicaid program said that state expects to get very little of the money.
The Illinois Department of Healthcare and Family Services expects to receive only $900,000 in repayments from WellCare, said spokeswoman Annie Thompson. While that amount amounts to less than 1 percent of WellCare's premiums, it could mean a welcome windfall for the Medicaid behavioral-health budget and Florida's Healthy Kids Corporation, which covers uninsured children in working-class families.
The documents that WellCare filed with the Securities and Exchange Commission on July 21 said that the Tampa-based company would restate its financials for 2004 through 2007 because of "accounting errors." The company was required by state law and contracts to spend at least 80 percent of the premium dollar in the behavioral-health sector on direct services to patients; if it spent less than that, it had to refund the difference to the state. The SEC filings indicate those refunds weren't made.
Last year, WellCare and other Medicaid contractors persuaded the Legislature to do away with the 80/20 rule for mental health, after WellCare and two other companies had to pay back $1 million or more for failing to comply with the 80/20 requirement in 2006. However, Gov. Charlie Crist vetoed the gift to HMOs as "anti-consumer" and said it had been attached to the budget bill in a back-room deal, not debated in public.
Manipulation of the books appears to be the focus of an ongoing federal and state Medicaid fraud investigation, which began Oct. 24 with a raid on WellCare's Tampa campus. No charges have been filed, but several lawsuits are pending.
