The allegations against Medicare and Medicaid HMO Advantage Company, Wellcare Health Plans are ugly — ugly enough to prompt the company to announce a pending settlement of 137.5 million. But the whistleblower who filed the Complaint — Sean Hellein, a former Wellcare financial analyst –may contest the settlement with claims that the actual damages are closer to between $400-600 million and should be doubled or trebled under the federal and certain state false claims acts. Hellein’s False Claims Act qui tam complaint alleges that Wellcare dumped sick newborns and expensive terminally-ill patients to boost profits and created dummy corporations to fraudulently shift costs to Medicare and Medicaid.  According to the Complaint, the Company’s Director of Corporate Development quipped:

“Why do we have so many efforts going on to inflate costs in Illinois, why don’t we just create a shell company like we do in New York and other states to avoid paying back the State?” — Dave Firdaus, Wellcare Director of Corporate Development, as quoted in Hellein’s whistleblower complaint

The Complaint is long and very technical but well-worth the read, painting a compelling picture of corporate greed and deceit:

THE WELLCARE WHISTLEBLOWER COMPLAINT 

To report Medicare Advantage cost-shifting schemes or other Medicare or Medicaid fraud, contact Frohsin & Barger.