The former WellCare administrators filed the lawsuit in May 2013, and the case remained under seal until last week when the government declined to join the case.
The complaint alleges Tom Tran, CFO at WellCare, said the company was losing “too much money” and needed to increase its denial rates at a meeting in 2012, which led to an increase in inpatient denial rates later that year, according to the report.
The complaint further alleges WellCare committed fraud by improperly collecting money from Medicaid and Medicare for enrollees even though the company wasn’t paying for medically necessary services for those individuals.
WellCare is yet to respond to the complaint and is still reviewing the case, according to the report.
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