WellCare Health Plans Inc. Will Pay $137.5 Million for Alleged FCA Violations

WellCare Health Plans Inc., based in Tampa, will pay $137.5 million to settle allegations of False Claims Act violations. WellCare provides managed health care services for Medicare and Medicaid beneficiaries throughout the country. The suit alleged various schemes which included submitting false claims to government health care programs, and included allegations that WellCare wrongly overstated the amount it claimed to be spending on medical care so that they did not have to return money to these government health care programs like Medicare and Medicaid. WellCare had also allegedly falsified data that altered the actual medical conditions of their patients and their respective treatments, to overbill for health related charges. On top of the medical allegations, WellCare allegedly participated in marketing abuses, including ‘cherrypicking’ of healthy patients so they could avoid future costs, as well as influencing some of the performance metrics regarding WellCare’s call center.

The recent ruling of the civil suits announced today brings the total recoveries from WellCare to $217.5 million, a number that is expected to continue to rise.

“The monies recovered in restitution and from this settlement agreement will go to the federal and state programs which suffered these losses, while the forfeited funds will go to law enforcement to help fund future investigations,” said Robert E. O’Neill, U.S. Attorney for the Middle District of Florida.

The relators or whistleblowers of these suits will each receive a share of the recovery. The financial analyst who previously worked for WellCare and who first initiated the qui tam complaint, will receive approximately $20.75 million. Three other relators will share $4.66 million and will then be entitled to receive a share of any contigency payment.

This case was investigated jointly by the Commercial Litigation Branch of the Justice Department’s Civil Division, the United States Attorney’s Office for the Middle District of Florida and the District of Connecticut, the National Association of Medicaid Fraud Control Units, the FBI, and the HHS-OIG.

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