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WellCare Health Plans Settles Whistleblower Lawsuits in Medicare/Medicaid Fraud Case for $137.5 Million

WellCare Health Plans Inc. has consented to pay $137.5 million to settle four whistleblower lawsuits filed against it over allegations of fraudulent Medicaid and Medicare claims. The health care provider is accused of falsely inflating the amount it claimed to have spent on medical care so it wouldn’t have return the money to Medicaid and programs, including Florida Healthy Kids and Florida Medicaid. WellCare offers managed health care service for about 2.6 million Medicaid and Medicare beneficiaries throughout the US.

The Qui Tam lawsuits also accused WellCare of keeping the overpayments for child care that it got from Medicaid, falsifying information that misrepresented the medical conditions that patients had and were treated for, operating a bogus Special Investigations Unit, manipulating performance metrics related to its call center, and committing marketing abuses.

U.S. Attorney Robert E. O’Neill said the settlement and restitution would go to the state and federal programs that sustained losses as a result of the Medicaid/Medicare fraud. Law enforcement will get the forfeited funds, which will go toward paying for future investigations.

Meantime, the whistleblowers that filed their cases under the False Claims Act should be getting back a percentage of what the US government recovers. For example, according to one Florida newspaper, whistleblower Sean Hellein is expected to receive close to $21 million for helping to instigate the federal government’s probe into WellCare. Hellein was a senior financial analyst at the health care provider when he secretly recorded executives talking about how to double bill for patient services in 2006. If WellCare didn’t spend a certain percentage of the money given to it by the government on care, it was supposed to give back the difference.

WellCare Health Plans whistle-blower to receive about $21 million, Tampa Bay Times, April 4, 2012

WellCare will pay $137.5 million to resolve fraud allegations, TBO, April 3, 2012


More Blog Posts:

$25M Whistleblower Settlement Reached in Hospice Fraud Case Against Odyssey Healthcare Inc., Boston Injury Lawyer Blog, March 25, 2012

Qui Tam Cases Result in $2.B Recovered in 2011, Boston Injury Lawyer Blog, January 4, 2012

Whistleblower Testifies on the Toll Medicaid Fraud Can Take On Patients, Boston Injury Lawyer Blog, December 16, 2011

Whistleblower Lawsuit: Hospice Care Provider Vitas Healthcare Accused of Medicare Fraud, Boston Injury Lawyer Blog, November 27, 2011
In Massachusetts, please contact our Boston injury lawyers if you think there is a whistleblower claim you might want to bring against an entity that committed fraud against the state or federal government. We are proud to represent individuals that are brave enough to help end fraud against the American people.