Tag Archives: medicare

U.S. AND NINE STATES WILL SHARE WELLCARE SETTLEMENT MONEY

The U.S. Department of Justice announced settlement of its claims against healthcare insurer, WellCare Health Plans, Inc., on April 3.  The federal government and nine other states, including Georgia, will share in penalty payments of $137.5 million to as much as $252.5 million.  The company will also bear the costs of implementing a Corporate Integrity Agreement and repairing the damage to its reputation damage inside and outside the company. Yes, compliance failures are always expensive.

These days there seems to be growing demand for accommodations in white-collar jails, too.  Several corporate officers were indicted, as has been the case with a number of healthcare fraud investigations in recent years.   This is also another case in which a company lawyer, this time the general counsel, was among those indicted for criminal conduct.  This is a trend that is of great interest to healthcare lawyers, for obvious reasons.  It is further confirmation that the days of the company lawyer being completely insulated from responsibility for the actions of his or her corporate clients are over.

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Here are excerpts from the press release:

WASHINGTON – WellCare Health Plans Inc. will pay $137.5 million to the federal government and nine states to resolve four lawsuits alleging violations of the False Claims Act, the Justice Department announced today. WellCare, based in Tampa, Fla., provides managed health care services for approximately 2.6 million Medicare and Medicaid beneficiaries nationwide.

     The lawsuits alleged a number of schemes to submit false claims to Medicare and various Medicaid programs, including allegations that WellCare falsely inflated the amount it claimed to be spending on medical care in order to avoid returning money to Medicaid and other programs in various states…  knowingly retained overpayments it had received from Florida Medicaid for infant care; and falsified data that misrepresented the medical conditions of patients and the treatments they received.

Additionally, it was alleged that WellCare engaged in certain marketing abuses, including the “cherrypicking” of healthy patients in order to avoid future costs; manipulated “grades of service” or other performance metrics regarding its call center; and operated a sham special investigations unit.

The settlement requires that WellCare pay the United States and nine states – Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York and Ohio ….

Read the entire press release.

Baxam Law Group is an Atlanta area law firm that serves clients in intellectual property and healthcare law matters. Connect with Baxam Law on Facebook or on Twitter @innovationlawyr.

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A Billion Dollar Plan to Reduce Hospital Errors, Infections and Repeat Admissions

Today, the Department of Health and Human Services quietly hosted (if that’s possible) a conference call to unveil its new Partnership for Patients initiative.  This initiative promised $1B in cash to hospitals, who eagerly participated in the call.  HHS says the purpose of this initiative is to find ways to reduce hospital infections and medication errors, and to prevent repeat admission of patients caused by lack of continuity in their care after they are discharged from the hospital environment.

According to HHS Secretary Kathleen Sebelius, “Americans go the hospital to get well, but millions of patients are injured because of preventable complications and accidents.”  On this basis, the Partnership for Patients is poised to spend $500M to fund research on best practices and model systems that reduce the occurrence of hospital-acquired infections and hospital errors by 40% by 2013. 

The initiative will also provide $500M for the Community-Based Care Transitions Program.  Hospitals are expected to use this money to develop ways in which patients can transition from a hospital to other patient care settings in ways that reduce the risk of readmission.  The goal is a 20% reduction in the number of patient readmissions by 2013.

Pragmatic hospital administrators who may see this initiative as an oasis of encouragement in the increasingly arid healthcare environment, but they might not have much choice but to do so.  What will probably happen somewhere down the road is that hospitals which cannot meet the standards for reduced errors will have to worry about the risk of cuts to their federal healthcare reimbursements.

 

Read today’s press release here.

Baxam Law Group serves entrepreneurs in healthcare.  Visit us at www.baxamlaw.com.