Recently, the U.S. Department of Justice announced that Florida-based WellCare Health Plans and Georgia-based Radiotherapy Clinics of Georgia LLC have paid $137.5 million and $3.8 million, respectively, to settle charges that they violated the False Claims Act.
The government alleged that WellCare, a Tampa-based insurer, submitted false claims to the Medicare and Medicaid programs. Specifically, WellCare was accused of inflating the amount it claimed to be spending on medical care to avoid returning money to Florida’s Medicaid program.
Additional charges filed against WellCare claimed that the health plan engaged in “cherrypicking” healthy patients to avoid future costs and manipulating its call centers’ performance metrics. WellCare will pay $137.5 million to the United States and nine states: Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York and Ohio.
Meanwhile, the allegations brought against Radiotherapy Clinics alleged that the health care provider billed Medicare for medical treatments on prostate cancer patients that were not medically necessary. Specifically, Radiotherapy Clinics overbilled Medicare for port films, for simulations, for pre-plans that were either not medically necessary or not ordered, and for physics consults that were either not medically necessary or reviewed by the doctor who ordered the consults.
WellCare and Radiotherapy Clinics are only the two latest examples of the government’s growing emphasis on combating health care fraud as a part of its Health Care Fraud Prevention and Enforcement Action Team or HEAT initiative.
U.S. Department of Justice press release announcing the settlement with WellCare Health Plans Inc.
One of several qui tam complaints filed in U.S. District Court against WellCare Health Plans.
U.S. Attorney's Office, Northern District of Georgia, press release April 3, 2012
Complaint of the qui tam relators filed in U.S. District Court in July 2008 against Radiotherapy Clinics.