WellCare Health Plans Inc. has agreed to pay $137.5 million to resolve allegations that the company violated the False Claims Act by falsely inflating its spending claims to avoid returning overpayments, retaining overpayments for infant care, misrepresenting patients’ conditions and treatments received, “cherrypicking” healthy patients to lower costs, manipulating performance ratings of its call center, and operating a sham special investigations unit.  The company entered a Deferred Prosecution Agreement as a result of a related criminal case in 2009, agreeing to pay $40 million in restitution and an additional forfeiture payment of $40 million, and has also entered into a five year Corporate Integrity Agreement with the HHS Office of Inspector General.  Criminal charges are pending against several WellCare executives and one employee has already pled guilty in connection with the allegations.

The case was initiated by four whistleblowers who individually filed qui tam suits against the WellCare.  The relators will share over $25 million for their efforts in bringing the case to the government’s attention.  Since January 2009, DOJ has recovered over $9 billion under the False Claims Act, $6.7 billion of which involved health care fraud.

Read the entire press release, “Florida-Based Wellcare Health Plans Agrees to Pay $137.5 Million to Resolve False Claims Act Allegations”