Industry News

WellCare Enters into Settlement with DOJ for False Claims Act Violations

Richard P. Kusserow | April 2012

WellCare Health Plans recently entered into a settlement agreement with the Department of Justice (DOJ) to resolve False Claims allegations.  WellCare agreed to pay a total of $137.5 million to the federal government and nine states: Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York and Ohio.  This settlement agreement will resolve four separate lawsuits brought against the corporation, with most arising from whistle blower complaints.

In a press release, DOJ alleged that WellCare submitted false Medicare claims and misrepresented the corporation’s spending on medical care to avoid refunding overpayments. The corporation was also accused to have knowingly received overpayments from the Florida Medicaid program and failed to return the improper payments.  In addition, DOJ claimed that WellCare violated federal marketing requirements by “cherry picking” potential members to keep the cost of care low.

DOJ noted that WellCare entered into a prior settle agreement in 2006 to resolve criminal and civil health care fraud allegations.  WellCare’s latest settlement brings the DOJ’s total amount recovered from the corporation to $217.5 million.

The DOJ Press Release on the WellCare settlement is available at:

Department of Justice.  “Florida-Based WellCare Health Plans Agrees to Pay $137.5 Million to Resolve False Claims Act Allegations.”  Justice News.  3 Apr. 2012.

About the Author

Richard P. Kusserow established Strategic Management Services, LLC, after retiring from being the DHHS Inspector General, and has assisted over 3,000 health care organizations and entities in developing, implementing and assessing compliance programs.