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April 03, 2012 12:00 AM

WellCare agrees to pay over $137.5 million in settlement

Beth Kutscher
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    WellCare Health Plans, Tampa, Fla., has settled four whistle-blower lawsuits alleging that it violated the federal False Claims Act.

    As part of the settlement, WellCare will pay the U.S. and nine states $137.5 million, plus interest, over a three-year period. The company could also face a $35 million payment if it is sold or sees a change of control within three years of the agreement.

    A news release from the U.S. attorney for the Middle District of Florida in Tampa noted that the settlement is not a determination of liability.

    The states involved are Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York and Ohio. The whistle-blowers who brought the suits will also receive a percentage of the payments.

    WellCare came under civil and criminal investigation in 2006 after allegations arose that it had engaged in a number of fraudulent activities, including inflating the costs of medical care, pocketing overpayments it had received for infant care, misrepresenting patients' medical conditions and treatments, and operating a sham Special Investigations Unit, among other practices.

    This is the second settlement the managed-care contractor has entered into to settle the charges. In May 2009, WellCare paid $40 million in restitution and forfeited $40 million under a deferred prosecution agreement with the U.S. attorney's office.

    Separately, WellCare said that the U.S. attorney for the Middle District of Florida and the Florida Attorney General's Office have agreed to an early termination of the May 2009 deferred-prosecution agreement. The early termination indicates that the company has met its obligations, and the criminal charges against the company will be dismissed within five days.

    Several former WellCare employees are also awaiting trial on criminal charges; one former analyst, Gregory West, has already pleaded guilty to a conspiracy charge and is awaiting sentencing.

    Three of the suits were brought in the Middle District of Florida and one in the District of Columbia.

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    • News
      • Current News
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      • Transformation
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      • ESG
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      • Regional News
        • Midwest
        • Northeast
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        • West
      • Digital Edition (Web Version)
    • Blogs
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      • HIMSS 2023
    • Opinion
      • Breaking Bias
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      • Letters
      • From the Editor
    • Events & Awards
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        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Digital Health Transformation Summit
        • ESG: The Implementation Imperative Summit
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Hospital at Home
        • - Workplace of the Future
        • - AI and Digital Health
        • - Future of Staffing
        • - Hospital of the Future (Fall)
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Sponsored Video Series - One on One
      • Sponsored Video Series - Checking In with Dan Peres
    • Data & Insights
      • Data & Insights Home
      • Hospital Financials
      • Staffing & Compensation
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