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WellCare Medicare Customers Have Options

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By RICHARD MULLINS | The Tampa Tribune

Published: February 20, 2009

TAMPA - Customers with Medicare insurance or drug coverage through WellCare Health Plans Inc. have a few options to consider, now that federal regulators cracked down on the company's practices.

Federal authorities Thursday ordered WellCare Health Plans Inc. to stop enrolling new people into its Medicare drug and health plans as of March 7.

Regulators cited a long list of problems: deceptive sales practices, delays with urgent customer problems, forged enrollment documents and the highest complaint rate in the nation.

WellCare officials said they are working with the regulator, the Centers for Medicare and Medicaid Services.

"We take CMS' concerns very seriously," said Heath Schiesser, WellCare's president and chief executive officer. "We are committed to complying fully with CMS requirements and serving the needs of our members."

Medicare officials have seen problems with such companies before, "but not to this extent," said Peter Ashkenaz, a spokesman for Medicare.

This presents a dilemma for current WellCare customers who might want to leave the company for another provider.

Open enrollment dates may restrict some beneficiaries from leaving WellCare.

Open enrollment for Medicare Advantage runs from Jan. 1 to March 31. During that period, people can leave WellCare and return to "fee for service" Medicare, but they have to keep their Part D prescription drug coverage plan with WellCare.

But there are other ways to make changes in the meantime. Customers who call Medicare can plead their case, and officials there pay special attention to hardship instances or dangerous problems with a provider, Ashkenaz said.

"That includes cases like not being able to get critical heart medicine," Ashkenaz said, and such problems are taken on a case-by-case basis.

WellCare faces a long road to restart enrollments.

The company must come up with a plan to fix problems, then hire an outside auditor to review the plan and company operations. Then federal authorities conduct their own audit of WellCare and review the case. Current rules say regulators must be satisfied the company isn't likely to relapse into problems.

In the meantime, stock in WellCare plunged $3.24 per share in mid-day trading, or about 23 percent, to $10.81 per share as investors absorbed the news. So far this year, one other plan has received such sanctions from the government. That was WellPoint Inc., an unrelated company.

WellCare's suspension of new enrollments does not affect current WellCare beneficiaries.

To change your Medicare health or prescription drug program, call Medicare offices at 1-800-MEDICARE (800-633-4227).

Reporter Richard Mullins can be reached at (813) 259-7919.

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