WellCare Health Plans, a health care provider based in Tampa, has agreed to pay more than $137 million to settle four whistleblower lawsuits, including three in Florida, alleging Medicaid and Medicare fraud, federal prosecutors announced.
WellCare, which provides managed health care services for about 2.6 million Medicare and Medicaid patients, will pay the money to the federal government, Florida and eight other states to resolve the claims.
The lawsuits alleged that WellCare falsely inflated reports of what it was spending on care to avoid returning money to Medicaid, the Florida Healthy Kids programs, and that it knowingly kept overpayments from Medicaid.
The complaints also alleged that the company engaged in certain marketing abuses, including “cherrypicking” healthy patients, along with other claims. The company will pay the money over three years, and may also be required to pay another $35 million if the company is sold or changes control within the three year time frame. The settlement was announced by Robert E. O’Neill, U.S. Attorney for the Middle District of Florida.
The company had earlier settled another complaint in 2009 related to the same issue. WellCare paid $40 million in restitution and forfeited an additional $40 million in that case. A former company analyst, Gregory West, pleaded guilty to conspiracy in connection with that case, and five former company executives were indicted last year and are awaiting trial scheduled to start next year, in that case.
In all, the company now will have paid $217.5 million to settle various civil suits in connection with the alleged fraud.
“This settlement should serve as notice to those defrauding state and federal healthcare programs that, in addition to appropriate criminal prosecutions, we will utilize civil suits to root out their conduct and recover their ill-gotten gains,” O’Neill said in a statement.
Four whistleblowers in the case will get money as well.
