Hollywood, Fla.-based Memorial Healthcare System, operated by the South Broward Hospital District, is being investigated by the U.S. Department of Justice after a whistleblower brought forth allegations that it had conspired with Tampa, Fla.-based WellCare to defraud Florida's Medicaid and Healthy Kids program, according to a Miami Herald report.
WellCare is a contractor with the non-profit organization Healthy Kids, which is authorized to provide Medicaid coverage to underprivileged children. In 2005, South Broward and Wellcare negotiated contracts for the Healthy Kids program, which outlined a maximum 15 percent administrative cost for patient care. Under the contract, if WellCare spent less than the remaining 85 percent, half of the profits had to be repaid to Healthy Kids.
According to a complaint filed by former WellCare financial analyst Sean Hellein, South Broward allegedly conspired with WellCare to make it appear WellCare was paying more for services than it actually was by inflating the cost of services by 31.6 percent. Additionally, South Broward allegedly transferred costs from other WellCare contracts to WellCare's Healthy Kids account. Mr. Hellein claims he was instructed not to discuss the details of the Healthy Kids contracts. The complaint does not specify how much WellCare saved in the alleged scheme, according to the report.
South Broward is not charged with a crime and is not a defendant in the whistleblower case, but its alleged role as a co-conspirator in the pending False Claims lawsuit against Wellcare is outlined in the complaint. It is not yet clear why South Broward would have allegedly assisted WellCare in its alleged fraud, according to the report.
Read the Miami Herald report about the South Broward investigation.
Read other coverage about false claims lawsuits:
- Justice Department Can Join Whistleblower False Claims Suit Against St. Jude Medical
- U.S. Files Suit Against Georgia Physician and Medical Center for Healthcare Fraud, Endangering Lives
- Justice Department Joins False Claims Lawsuit Against Georgia's Satilla Regional Medical Center and Physician
WellCare is a contractor with the non-profit organization Healthy Kids, which is authorized to provide Medicaid coverage to underprivileged children. In 2005, South Broward and Wellcare negotiated contracts for the Healthy Kids program, which outlined a maximum 15 percent administrative cost for patient care. Under the contract, if WellCare spent less than the remaining 85 percent, half of the profits had to be repaid to Healthy Kids.
According to a complaint filed by former WellCare financial analyst Sean Hellein, South Broward allegedly conspired with WellCare to make it appear WellCare was paying more for services than it actually was by inflating the cost of services by 31.6 percent. Additionally, South Broward allegedly transferred costs from other WellCare contracts to WellCare's Healthy Kids account. Mr. Hellein claims he was instructed not to discuss the details of the Healthy Kids contracts. The complaint does not specify how much WellCare saved in the alleged scheme, according to the report.
South Broward is not charged with a crime and is not a defendant in the whistleblower case, but its alleged role as a co-conspirator in the pending False Claims lawsuit against Wellcare is outlined in the complaint. It is not yet clear why South Broward would have allegedly assisted WellCare in its alleged fraud, according to the report.
Read the Miami Herald report about the South Broward investigation.
Read other coverage about false claims lawsuits:
- Justice Department Can Join Whistleblower False Claims Suit Against St. Jude Medical
- U.S. Files Suit Against Georgia Physician and Medical Center for Healthcare Fraud, Endangering Lives
- Justice Department Joins False Claims Lawsuit Against Georgia's Satilla Regional Medical Center and Physician