Thursday, May 6, 2010

Wellcare caught with their hand in the cookie jar again

On April 28, Wellcare Health agreed to repay the state of Illinois about $1 million in overcharged capitation payments.  Wellcare does business in Hawaii as Ohana, one of the two for-profit health insurance companies providing services for the state's aged, blind and disabled population.

In May 2009, Wellcare avoided federal prosecution for Medicaid fraud by paying Florida Medicaid $80 million.  The fraudulent $40 million Wellcare had stolen from Florida included money that went to the state's EPSDT program for children with disabilities, and funds that went to help the aged population in Medicare.

Also in 2009, CMS struck Wellcare from the Medicare provider list, calling it "one of the overal worst performers among all [Medicare provider] plans".  The letter from CMS also referred to the company's poor record in properly processing grievances, and that the company's "complaints are three times the national average."

This is the company that Hawaii's elderly and disabled population depend on for providing them with the Medicaid services they need to stay out of institutions. 

Ohana's capitation payment for institutionalized individuals is higher than what the company receives if the patient is treated in their home.  As an example, for girls such as my daughter, Ohana will receive anywhere from $1,000 to $4,000 a month more in capitated payments if the child is institutionalized, depending on the island.

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About Me

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I'm the mom of a child with disabilities. Hannah's first neurologist said she might never develop beyond the level of a 2 month old infant, and there wasn't anything I could do about it. The brain damage was just too severe. Nine years later, she walks, uses a touchscreen computer and I've just been shown she can learn to construct sentences and do simple math with the right piece of technology. Along the way, I discovered I needed to teach myself what Hannah's rights to services really were. Learning about early intervention services led to reading about IDEA and then to EPSDT. I've been waiting for the Obama administration to realize the power and potential of EPSDT for the medical rights - including the right to stay at home with their families - of children with disabilities. The health reform people talk about long term care, and the disability people talk about education and employment, but nobody is talking about EPSDT. So I am.