WellCare Raid Sought Records Of 'Monetary Overpayments,' Warrant Says

Main Category: Medicare / Medicaid / SCHIP
Article Date: 21 Nov 2007 - 9:00 PDT

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Although the "exact nature of the investigation remains unclear," federal authorities were searching for records of "any monetary overpayments" when they raided WellCare headquarters on Oct. 24, according to the search warrant, the St. Petersburg Times reports. Tampa, Fla.-based WellCare, which provides Medicare and Medicaid managed care plans to about 2.3 million beneficiaries nationwide, in 2006 received nearly $4 billion in revenue from government sources.

Federal authorities during the raid seized thousands of documents, copied data from dozens of hard drives and took several laptops, including one used by company CEO Todd Farha. One day after the raid, a former WellCare fraud investigator filed a sealed whistleblower lawsuit in Tallahassee, Fla.

According to the Times, investigators were specifically interested in "documents dealing with Medicaid, the state of Florida and WellCare's mental health subsidiary, Harmony Behavioral Health." One month after the raid, documents that were sealed have been released by the U.S. Attorney's Office in Tampa, Fla. WellCare spokesperson Amy Knapp declined to comment on the documents, saying they "contain proprietary information." One of the released documents was titled, "Jo-Jo phantom accounts analysis - Florida miscoding." There also was a letter to "get around Medicaid requirements" and another titled "docs re: possible kickback."

Carl McDonald, an analyst for CIBC World Markets, said that the investigation should last another six to 12 months. "The obvious question is whether the government would send in 200 agents in a raid in order to recover a relatively insignificant amount, or if they have their sights set on something more than that," he said, adding, "We think the investigation will prove to be broader than this one issue, so there are likely more negative headlines to come as further details of the investigation are released" (Hundley, St. Petersburg Times, 11/20).

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