Whistleblower Lawsuits: WellCare Health Plans Settles Medicare/Medicaid Allegations for $137.5 Million

Four whistleblower lawsuits accusing WellCare Health Plans, Inc. of submitting false Medicaid and Medicare claims have ended with the company agreeing to pay $137.5 million to settle the allegations made. The lawsuits were filed under the federal False Claims Act’s qui tam provisions, and whistleblowers are entitled to a share of the settlement.
Per the whistleblower lawsuits, WellCare Health Plans engaged in several schemes to turn in false claims to Medicaid and Medicare programs. Alleged tactics included inflating how much it claimed it was spending on medical care so it wouldn’t have to give money back to Medicaid and other state programs, keeping the overpayments for infant care it got from Florida Medicaid, taking part in “cherrypicking” health patients so as to not have to pay future costs, committing other marketing abuses, falsifying information so that patients’ medical conditions and the treatments they obtained were misrepresented, manipulating performance metrics related to its call center, and running a bogus Special Investigations Unit.
Under the terms of the qui tam settlement, WellCare must pay the $137.5 million, plus interest, to the US government and the states of Florida, Connecticut, Hawaii, Georgia, Indiana, Illinois, New York, Missouri, and Ohio. If the company is sold or undergoes a change in control within the next three years, it also might have to pay a $35 million contingent payment.
This is the second monetary settlement that WellCare has agreed to pay since the government began a civil and criminal probe into the company six years ago. In 2009, WellCare agreed to pay $80 million in restitution and other matters to resolve possible criminal charges over losses by the Florida Medicaid and Healthy Kids programs.
Under the False Claims Act, whistleblowers that file a complaint are entitled to a percentage of what the US government gets back. The first whistleblower to initiate the case against WellCare, financial analyst Sean Hellein, will get about $20.75 million. The three other whistleblowers will share about $4.6 million and they may get more if WellCare does make a contingency payment,

If you are someone who is considering blowing the whistle against an entity or individual that you think may be defrauding the US government or a state, there are a number of whistleblower legal requirements that you should know about:

• The fraud that you wish to report can’t have yet been disclosed in a government report or the media.
• The fraudulent act needs to have been committed against a government entity that has a law allowing for whistleblower claims to be brought.
• A whistleblower claim generally has to be submitted within six years of the fraudulent act. In certain cases, however, the statute of limitations for bringing a qui tam lawsuit is 10 years.
• A member of the Armed Forces cannot bring a whistleblower claim against a fellow Armed Forces member.
• Whistleblower claims cannot be brought against a judicial official, a Congress member, or a senior branch executive member.
You should also know that under the ‘first to file’ rule, the first person to file a whistleblower claim against a company or individual will likely be the one to get the majority, if not all, of what the government gets back from the wrongdoer.
Please contact our whistleblower lawyers at The Gilbert Law Group® today.
WellCare Health Plans, Inc. Agrees To Pay $137.5 Million To Resolve False Claims Act Allegations, Justice.gov, April 3, 2012
WellCare Health Plans whistle-blower to receive about $21 million, Tampa Bay Times, April 4, 2012


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