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WellCare Health Plans, Inc. is an American health insurance company that provides managed care services primarily through Medicaid, Medicare Advantage and Medicare Prescription Drug plans for members across the United States. WellCare began operations in 1985 and has its headquarters in Tampa, Florida.
Following that submission, the payor will respond with an X12-997, simply acknowledging that the claim's submission was received and that it was accepted for further processing. When the claim(s) are actually adjudicated by the payor, the payor will ultimately respond with a X12-835 transaction, which shows the line-items of the claim that will ...
The California Department of Health Care Services (DHCS) is a department within the California Health and Human Services Agency that finances and administers a number of individual health care service delivery programs, including Medi-Cal, which provides health care services to low-income people.
Covered California is the health insurance marketplace in the U.S. state of California established under the federal Patient Protection and Affordable Care Act (ACA). The exchange enables eligible individuals and small businesses to purchase private health insurance coverage at federally subsidized rates.
In 1979, Chapter 12 of the California Insurance code established the "Bureau of Fraudulent Claims" to investigate criminal insurance violations. In 1980, the fraud investigators became sworn peace officers under Penal Code 830.3(i). In 1988, the Bureau of Fraudulent claims was reclassified as the "Fraud Division."
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In 2012, James Hoyer represented one of four whistleblowers in a qui tam case against WellCare Health Plans, Inc that resulted in a $137.5 million settlement. [13] The lawsuits alleged a number of schemes to submit false claims to Medicare and various Medicaid programs.
The California insurance commissioner has been an elected executive office position in California since 1991. Prior to that time, the insurance commissioner was appointed by the governor. The officeholder is in charge of the California Department of Insurance. The current insurance commissioner is Democrat Ricardo Lara.