WellCare, United, others cheat Florida kids program

Jul 27, 2011

The following article was published in the Miami Herald on July 27, 2011:

Wellcare, United, others, cheat Fla. Kids’ program

By Kelli Kennedy

Four private health insurers who wrongly claimed they spent millions on patient care in the state’s children’s health care program also provided coverage to patients in Florida’s controversial Medicaid privatization program.

AmeriGroup Florida, Inc., Vista Health Plan, United Healthcare and WellCare were required to spend at least 85 percent on medical services under the State Children’s Health Insurance Program in an effort to ensure for-profit companies are not lining their pockets with state funds instead of spending it on patient care.

If an insurer spends less, it must refund 50 percent of the shortfall to the state. Florida health officials should have received $3.1 million in refunds between 2003 and 2007, according to a report by the Department of Health and Human Services’ inspector general.

The Associated Press obtained the insurers names as part of a public records request.

United Healthcare spokesman Tyler Mason said in an email that all participating plans with the state program provide quarterly reports for review to ensure payment accuracy and reconcile any issues based upon the contracted Medical Loss Ratios agreement.

The investigation comes as Florida is poised to expand a five-county Medicaid program statewide. Health advocates have criticized the state’s lax oversight of the for-profit companies in the Medicaid pilot program, especially as news comes that the same insurers erred in other Florida health programs. Patients in the pilot complained they couldn’t get appointments and were denied medications.

AmeriGroup, Vista and WellCare eventually dropped out of the Medicaid pilot, claiming they couldn’t turn a profit. United is serving patients in Duval, Baker, Clay and Nassau counties after exiting Broward.

But after Gov. Rick Scott signed bills expanding the program statewide, experts say these companies and others will be clamoring for lucrative state contracts.

Supporters say the bills injected sorely needed accountability into the program, including a yearly, independent audit.

The bills don’t require plans to spend certain percentages on patient care and administrative costs, but instead require them to repay profits over 5 percent to the state.