Consumer Fraud

Whistleblower receives $21 million for exposing health care fraud

Pills Stethascope on Money 435x289 Whistleblower receives $21 million for exposing health care fraudA former senior financial analyst for a Florida-based health plan provider will receive nearly $21 million for his role in exposing his employer’s fraudulent business practices, which involved double billing Medicare and Medicaid.

According to the Tampa Bay Times, Sean Hellein, who worked for WellCare Health Plans in Tampa, secretly recorded company executives in 2006 discussing ways to double bill the government health programs. As an administer of managed-care plans for 2.6 million Medicare and Medicaid patients, WellCare is required to refund a percentage of unspent funds.

Mr. Hellein’s information led to an FBI raid on WellCare’s Tampa headquarters in October 2007 and set in motion legal proceedings against the company, including recovery of stolen funds and criminal charges against top executives.

Under the False Claims Act, whistleblowers whose information leads to the successful recovery of government funds are entitled to receive a percentage of those funds.

Whistleblowers have become one of the federal government’s most valuable tools in its ongoing efforts to crack down on corporate wrongdoing and recover money lost to overbilling and other fraudulent activities. For every $1 the federal government spends pursuing whistleblower-initiated fraud investigation, it recovers $7, and tougher new laws promise to make pursuing whistleblower claims even more worthwhile.

Health care is one industry that is particularly rampant with financial fraud, and it’s fallen at the center of recent bipartisan efforts in Washington to fight back. A congressional coalition beefed up the False Claims Act in 2009, making it easier for the government to use the law. Additionally, the Obama Administration has called for better fraud-busting health care laws and a bigger budget to use them effectively.

According to the Tampa Bay Times, the federal government’s total recovery of funds amounts to $217.5 million, including civil suit resolutions. Funds from restitution and settlements will be returned to federal and state health care programs that were defrauded by WellCare, and forfeited funds will go to law enforcement to help fund future investigations.

Three other parties in the WellCare whistleblower case will split about $4.6 million.

While most of the financial claims have been resolved, five former WellCare executives still face criminal charges related to the fraud, including CEO Todd Farha, chief financial officer Paul Behrens, and general counsel Thaddeus Bereday.

For more information about whistleblower laws, visit www.beasleyallen.com.

Sources:

Tampa Bay Times

USA Today