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WellCare Medicare-Advantage Scandal

13 Responses

1. Thomas Brown, on February 27, 2009 at 12:00 AM said:

   I like this article and the fact that it seems to be fairly unbiased … I was interested to know of Dr. Herzlinger’s involvement in WellCare’s BOD and her sale of a bunch of stock.

   With many friends and family I know personally who are on WellCare’s MA plans in my area (and all with the same agent [who works directly for WC; not an independant]), I can honestly say that WellCare’s Medicare Advantage plans work EXTREMELY well, and everyone who I know who has taken advantage of what these programs offer is ELATED with WellCare’s products … as I’m sure other options or other companies may work for other people.

   Medicare Advantage is an EXCELLENT program for all involved; Ins. Company, Government, and Member alike. The Member get’s extra benefits (… and WellCare’s are better than ANY OTHER in our area), the company obviously makes money, and the government pays a PREDICTABLE cost to cover ALL healthcare for a Medicare Advantage member rather than paying unpredictable costs as services are rendered.

   I get so tired of the political rhetoric that floods the message boards, etc. when something like this happens. And, by the way, as I’m sure you know, so far this year, Anthem has already been suspended, now WellCare, and United Healthcare is CONSTANTLY in trouble for they way the break the rules. People want to jump on the insurance company for trying to make a profit; when in actuality – the problem is age-old, and occurs in every single type of product, service or anything else … It is the ‘bad apple spoiling the bunch’ in terms of sales people. It doesn’t matter if I sell cars, web page subscriptions, mortgages, or vacuum cleaners; if I’m willing to do whatever is necessary to make the almighty dollar, I am going to mislead, lie, cheat, steal, or stab someone in the back to get the money. It absolutely is common in EVERY SINGLE ARENA. These companies hire some employees directly, where oversight can be maintained to assure that the agent is being compliant with applicable company rules or laws … BUT, they are also relying on outside agencies and independant insurance agents contracted to sell their products. In the latter case, there is no oversight possible, and many independant insurance agents make 100% commission (no base salary), and will do anything to sell the product they wish to sell in order to feed their family. If we also sprinkle some honesty into the psyche of the human mind – 99.99% of agents who are relying solely on commission, and who are contracted with multiple companies, are going to steer people toward the company that pays the highest commission, whether or not that is the right fit for the individual.

   In addition, people who lie, cheat, steal, and mislead to make a buck are usually higher producers, so the company is in a quandry, too. Do we punish this person or terminate his contract because we receive numerous complaints about consumers being mislead, or should we keep him contracted so we can make our profits on the large number of members he brings us … If you or me or anyone else was the CEO of the company, and again, applying a little honesty, we’d be reluctant to yank his contract too.

   It’s a shame that ignorance prevails when something like this happens, and people jump on the opportunity for a ‘pulpit’ to preach political views regarding the insurance company ‘fat cats’ who make all kinds of money, and how the big bad insurance company has the NERVE to actually try to make a profit; and ALL the insurance companies lie to EVERYBODY to make a quick buck … I’ve got news for them, and this is speaking from experience with my own family members. As we age, the mind deteriorates just like everything else. Many seniors don’t remember what they ate for breakfast, much less whether or not the insurance agent told them this or that … THEY FORGET, BUT CAN’T be honest and TAKE THE BLAME themselves, SO THEY COMPLAIN THAT THE AGENT MISLEAD THEM.

   So, THANK YOU for writing a somewhat unbiased breakdown of these events …

   I do have a question, however.

   As I read your page, and look around, and read all the different places that it talks about your credentials … financial planner, medical planner, best-selling author, ‘recovering insurance agent’, speaker combined with all of the links on your site offering quotes on services, etc.

   Don’t you think that it’s a little bit misleading as well?

   Thomas Brown

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2. Dr. Marcinko, on February 27, 2009 at 12:56 AM said:

   Tom,

   Many thanks for reaching out to us. It is obvious that you are passionate and knowledgeable about this topic. Feel free to subscribe, post, read, rant and rave, anytime.

   As a doctor and insurance agent, I will say that Medicare Advantage plans, or similar, are not all appropriate for all patients. Having said that – I am pleased that your MA experience with WellCare was a good one – and I encourage you to work with intermediary agents of integrity.

   We do try to be unbiased in our reporting and add experiential value to any post. And, please review our interview on fiduciary responsibility by Ben Aikin; as well as our post on journalism, experts and healthcare reportage.

   Now, regarding my credentials, you said; and I quote,

   “As I read your page, and look around, and read all the different places that it talks about your credentials, financial planner, medical planner, best-selling author, ‘recovering insurance agent’, speaker combined with all of the links on your site offering quotes on services, etc. Don’t you think that it’s a little bit misleading, as well?”

   Well Tom, to answer you directly, simply and with all humility; I don’t!
   Why not? Because, it is all true!

   PS: There is not a “quote” to be found, that I can see.

   CV Link: https://healthcarefinancials.wordpress.com/dr-david-marcinko%e2%80%99s-bookings/

   For example, Editor Jennifer Boulden recently contacted us to arrange my interview for Medical Business News, Inc., the publisher of Medical News of Arkansas. With a professional readership comprised of physicians and key industry decision makers, Medical News publications are devoted entirely to healthcare issues that impact both clinical and administrative best practices. So, look for our April post on same.

   All the best – in the interest of transparent full disclosure.

   Dave Marcinko
   Founder, CEO and Publisher-in-Chief
   [Atlanta, GA]
   http://www.HealthcareFinancials.com
   http://www.MedicalBusinessAdvisors.com
   http://www.HealthDictionarySeries.com
   http://www.CertifiedMedicalPlanner.com

   Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com or Bio: http://www.stpub.com/pubs/authors/MARCINKO.htm

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3. Don, on February 27, 2009 at 12:55 PM said:

   Hello Tom and Others,

   President Obama promised that he would cut overpayments to Medicare Advantage plans by about $15 billion dollars, annually.

   Of course, this news was already reflected in the stock price of for-profit health insurers.

   Ultimately however, when Obama’s budget came out demonstrating that it would cut Medicare payments by about the same amount, these stocks tanked?

   Think about it!
   Don

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4. Sam, on March 1, 2009 at 2:32 AM said:

   MAPs,

   Excellent post Dr. Marcinko; but it’s not all about WellCare. Don’t forget MA Plans from Humana and UHC; were down 24% and 15% respectively, this quarter.

   Also: Coventry Health Care down 14%; Aetna down 13%; and Cigna down 9%.

   Sam

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5. Hope Hetico, on March 17, 2009 at 7:25 PM said:

   Sam, Don and Tom,

   The Obama administration wants to eliminate the subsidies that the government pays insurers that sell Medicare Advantage managed-care plans. Instead, MA plans would be put under a competitive bidding process.

   Q: Are Medicare Advantage plans unfairly subsidized and should they have to face the financial pressure of payments closer to Medicare fee-for-service plan levels?

   Hope Hetico; RN, MHA
   Certified Medical Planner™
   http://www.CertifiedMedicalPlanner.com

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6. John Gardiner, on April 14, 2009 at 2:10 PM said:

   My wife is enrolled in Part D Medicare—we’ve had 3+ months of headaches with the billing department of this bunch of incompetents.

   John Gardiner

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7. Betty, on April 14, 2009 at 2:15 PM said:

   Hi John,

   Now, tell us what you really think about MA Plans.
   Seriously, I am not surpirsed. I used to sell stuff like this, and had to quit.
   Sorry, but just be patient.

   Betty

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8. Margaret, on April 21, 2009 at 9:47 PM said:

   Thank you for this information. I worked in physician offices for the past 17 years, most of which was the head biller. When Medicare Advantage plans first stepped onto the scene it was a nightmare. It was dozens of HMO’s for seniors. The paperwork multiplied and the endless hours on the telephone for referrals and waiting for call backs. AAGGHH !!

   In recent years, the improvement is like night and day. We are used to them and they are used to us.

   I have a senior parent and after reviewing many of the plans offered out there I chose Wellcare, for him, in 2007. Wellcare has treated my dad very well. Knowing the industry from the physicians point of view and now from the patient’s point of view I have an understanding unsual to most.

   Wellcare is not the best plan available, if it doesn’t meet your specific needs. It is the best plan available, in our area, for my dad. There are limitations we have had to deal with, but once you know them you can more easily adapt to them. No insurance covers everything at 100% and I believe that is America’s biggest misconception about insurance.

   We are purchasing a product. If you buy a product that you haven’t researched and it doesn’t meet your needs you either live with it, replace it, or return it. I suggest we research the products we purchase more completely. If you don’t know what you are looking for, seek guidance from someone that knows about what is being offered.

   Don’t get stuck with something that doesn’t work for you. Thank you for this opportunity to share.

   Margaret

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9. Mary, on April 22, 2009 at 10:20 AM said:

   Margaret,

   Very well said; and I’m glad you secured a good fit for your dad. Unfortunately, many of us do have a misconception about “insurance”, but the collaborative interaction you suggest may be the key to enhanced success.

   Mary

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10. Jim, on June 1, 2009 at 8:01 PM said:

    Higher Medicare Advantage Costs in 2010

    Forget the scandal for now. If you’re one of more than 10 million subscribers to Medicare Advantage plans, expect to pay more for coverage next year. The U.S. Centers for Medicare and Medicaid Services cut 2010 subsidies to private Medicare Advantage plans by 4% to 4.5%. Big private insurers offering the plans will be figuring out how to adjust to the reductions, but you can expect to see a combination of higher rates and drug costs along with reduced coverage.

    The plans were created by the Bush administration as a private-sector alternative to traditional Medicare plans. But Medicare Advantage costs the government about 14% more per person than regular Medicare and thus became a target for expense cuts that could be used to help pay for the Obama administration’s health-reform plan.

    Link: http://articles.moneycentral.msn.com/RetirementandWills/CreateaPlan/5-big-financial-changes-for-retirees.aspx

    James

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11. Angela, on July 7, 2009 at 5:40 PM said:

    MA Plans were created as a private sector alternative to traditional Medicare and have been successful overall in managing health costs for their populations. The 14% more per person than regular Medicare can be traced back to poor governmental management from a reimbursement and regulatory standpoint. After creating an idea that should drive costs down through competition, they have systematically leveled the playing field and continued to put more and more stringent regulatory requirements in place for MA Plans. More requirements than traditional Medicare has by a long shot. Though I agree that there must be standards in place to assure that beneficiaries receive the care they should and are not misled, there is such a thing as overkill. If the regulatory requirements cost more to maintain than someone’s health, the MA Plans strive to meet them all only to have the rules change so frequently that they are sure to fall short and reimbursement is cut so it isn’t possible to maintain all the added benefits that traditional Medicare does not provide, then is this the same idea the Bush administration set out to execute. I think not. The sad part is that the beneficiaries are the ones that end up losing in the current environment regardless …

    Angela

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12. Sarah, on August 30, 2009 at 4:00 PM said:

    Betty and John,

    Wellpoint is the former non-profit Blue Cross of California that converted into a very profitable for-profit corporation, and represents the epitome of for-profit [greedy] insurers, in my opinion.

    Sarah

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13. Reston, on June 29, 2010 at 11:53 AM said:

    The FCA and WellCare

    WellCare Health Plans in Tampa, Fla., just reached a preliminary deal with the civil divisions of the U.S. Department of Justice and the U.S. Attorney’s Offices for the Middle District of Florida and Connecticut to settle False Claims Act allegations of accounting fraud to a Securities and Exchange Commission (SEC) filing, reports Health News Florida.

    http://www.healthnewsflorida.org/index.cfm/go/public.articleView/article/18312

    Reston

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