As changes in the impending health care arena create apprehension for some providers and many patients, Wayne Long, CEO of Well Care Home Health and Home Care, sees this as a unique opportunity. “Well Care has been a trusted health care agency in southeastern North Carolina for 25 years, the industry is changing and we must change and adapt to the needs of patient care.” As Medicare and Medicaid rules will most certainly change in the coming months and years, the gaps in services will be difficult for patients to understand. “We have a responsibility to serve the local communities and assure patients receive the best home health care available,” said Long in a statement earlier this week at the announcement of his March 5, 2012 acquisition of At Home Quality Care, based in Raleigh North Carolina. The previous agency owner served 500 patients per year in home heath, where over 45,000 patients qualify and need home health services. Long went on to say, “The cost of hospitalization is increasing, the health care needs of patients with chronic diseases are complex and elderly patients want to remain at home and independent for as long as possible. At Well Care, we can help patients receive the care they need, and will be a partner in containing the rising health care costs of the Medicare and Medicaid population in the Triangle.”
Video: WellCare Medicare Advantage – I Am Well Cared For.mov
The Basics of a WellCare Medicare Plan
Medicare is a federally backed healthcare plan that is provided to those individuals who are over the age of 65, or those who are already receiving Social Security benefits. Those who are also younger than 65 and not receiving Social Security benefits, but have certain disabilities that qualify them for the program are also eligible. This type of healthcare is more affordable than a wide majority of private health insurance programs, and is generally available to those who are over 65 because they are no longer working and in need of healthcare.
WellCare Health Plans, Inc. Pays $137.5 Million to Resolve Allegations that it Committed Medicare and Medicaid Fraud
The lawsuits alleged that WellCare inflated the amount it claimed to spend on medical care to avoid returning money to Medicaid, and it retained overpayments it received from the Florida Health Kids program. In addition, the DOJ claimed that WellCare falsified data to misrepresent the medical conditions of patients and the treatments they received, abused the market by “cherry picking” healthy patients to avoid higher costs, manipulated performance metrics at its call center, and operated a sham Special Investigations Unit.
Meet with Congresswoman Schakowsky’s office
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Wellcare Medicare Advantage 2012
Tracks proposed policy. Develops corporate positions related to Medicaid/Medicare policy. Develops communication tools to convey corporate position on proposed policy. Collaborates with internal stakeholder in the development of policy positions and communication tools. Essential Functions: Tracks activity of the federal register, CMS, HHS and, to the extent required by the markets, state Medicaid and/or Medicare programs Reviews and monitors proposed Medicaid/Medicare related rulemaking impacting the managed care industry Consults with key stakeholders and SMEs throughout the organization to determine the impact of the proposal on the enterprise Partners with co-workers to determine the business impact of proposed rules. Develops proposed corporate positions on proposed policies for presentation to and approval by the public policy steering committee. Based on defined positions, develops rule comments to be distributed by WellCare or by and through our trade association in response the key proposals. Develops white papers, memoranda and presentations to inform key business leaders, including government affairs personnel, about regulatory developments and positions Collaborates with public policy team members and government affairs team to determine the appropriate methodology and mechanism for conveying corporate positions to key policy makers. Other duties as assigned Source: apha.org
WellCare Health Plans to Pay $137.5 Million to Settle False Claims Act Lawsuits
Under the terms of the settlement, WellCare will divide up the $137.5 million between the federal government and nine different states: Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana Missouri, New York, and Ohio. The settlement will be paid out over the course of 36 months, plus interest. This settlement is the second one reached with WellCare since the government began its civil and criminal investigations into the company in 2006. The previous settlement totaled $80 million. Additionally, five former executives of the company were indicted in March of 2011 and are awaiting trial.
WellCare Health Plans pays $137.5 million to settle fraud allegations
This is the second monetary settlement reached with WellCare since the government initiated a criminal and civil investigation of WellCare in 2006. On May 5, 2009, in order to resolve potential criminal charges related to losses by the Florida Medicaid and Healthy Kids programs, WellCare entered a Deferred Prosecution Agreement (DPA) with the U.S. Attorney in the Middle District of Florida, under which WellCare paid $40 million in restitution and forfeited an additional $40 million. The U.S. Attorney’s office also has pursued criminal charges against several former Wellcare employees. One former WellCare analyst, Gregory West, entered into a plea agreement and pleaded guilty to a conspiracy charge shortly after execution of a search warrant on WellCare’s corporate headquarters in Tampa; he is currently awaiting sentencing. Five former executives – including former CEO Todd Farha, former CFO Paul Behrens and former general counsel Thaddeus Bereday – were indicted in March 2011 and are currently awaiting trial, which is presently scheduled for January 2013. Additionally, Wellcare previously executed a Corporate Integrity Agreement (CIA) with the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG) that imposes compliance obligations on the company for a period of five years.
Medicare & Medicaid Cases Settle Under False Claims Act
The False Claims Act contains provisions called qui tam provisions which allow private parties to file a lawsuit on behalf of the U.S. These private parties, called relators, are able to share in any recovery obtained. In the WellCare case, one relator—a former WellCare financial analyst whose claim initiated the government investigation—will receive $20.75 million. Three other relators will split an estimated $4.66 million and receive a share of contingency payments.
WellCare Settles Massive Healthcare fraud
Mahany & Ertl is a full service boutique law firm that concentrates in combatting fraud anywhere it may be found. Healthcare, mortgage fraud, Ponzi schemes, phony welfare benefit plans and investment frauds – we are here to help victims get back their hard earned money. Presently we are prosecuting the largest false claims case against a mortgage lender in the U.S. – HUD’s $2.4 billion claim against Allied Home Mortgage. We proudly represents whistleblowers and welcomes comments and questions – For more information, contact attorney Brian Mahany at (414) 704-6731 (direct) or by email at email@example.com. All inquiries are kept in strict confidence.
WellCare Health Plans Inc. Will Pay $137.5 Million for Alleged FCA Violations
WellCare Health Plans Inc., based in Tampa, will pay $137.5 million to settle allegations of False Claims Act violations. WellCare provides managed health care services for Medicare and Medicaid beneficiaries throughout the country. The suit alleged various schemes which included submitting false claims to government health care programs, and included allegations that WellCare wrongly overstated the amount it claimed to be spending on medical care so that they did not have to return money to these government health care programs like Medicare and Medicaid. WellCare had also allegedly falsified data that altered the actual medical conditions of their patients and their respective treatments, to overbill for health related charges. On top of the medical allegations, WellCare allegedly participated in marketing abuses, including ‘cherrypicking’ of healthy patients so they could avoid future costs, as well as influencing some of the performance metrics regarding WellCare’s call center.
Wellcare Medicare Advantage 2012
[...] Wellcare offers Medicare Advantage plans that consists of HMO, HMOPOS, and PFFS networks. The plans offered depend on where you live because they are county specific. The HMO network is extensive in areas like Florida and is very popular because of the amount of options available to you. Also popular with Wellcare is the Medicare/Medicaid programs available as well. Wellcare offers 2 Medicare/Medicaid programs in parts of Florida as well as other areas that most other plans do not offer. These plans benefit both full Medicaid beneficiaries and partial Medicaid beneficiaries. The Medicaid plans will be labeled as SNP for Special Needs and offer additional benefits that you would not receive with just Medicare and Medicaid. They also do not cost any additional premium to the beneficiary. Wellcare also offers in some areas two regular Medicare Advantage plans. One plan is designed with basic benefits and no premium while the other plan offers better benefits and a small monthly premium. The plan names vary geographically and can be found at http://www.wellcare.com.Source: medicare-plans.net [...]