Wellcare began operations in 1985 and is located in Tampa Florida it is a subsidiary of Centene Corporation. Wellcare Health Plans, Inc. is the holding company for several subsidiaries, including WellCare, Meridian Health Plan, Staywell Health Plan, ‘Ohana Health Plan, Care1st Health Plan Arizona, and Missouri Care, among others.
The former general counsel for WellCare Health Plans has been sentenced to six months in federal prison for his position in a scheme to defraud Florida’s Medicaid program. WellCare declared in a report that it had fully engaged in the research and that matters immediately related to the company had been resolved. According to Reuters, The other four executives—former WellCare President and CEO Todd Farha, former Chief Financial Officer Paul Behrens, former Vice President of Clinical Services
William Kale, and former Vice President of Medical
Economics Peter Clay—were found guilty of fraud-related charges in 2013.
The four executives appealed, asserting that there was not sufficient proof to show they had perpetrated the crimes. Notwithstanding the fraud case that captured its top executives, WellCare proceeds to profit from its Medicaid business. Medicaid fraud arrest caught the eye of legislators in late 2015, and late last year the OIG recommended a new rule extending the authority MFCUs have to investigate and prosecute abuse.
The year 2012 Attorney General Sam Olens published that Georgia is one of nine states that, accompanying the federal government, have established accusations against WellCare, a health support organization.
WellCare had inserted into agreements with several States’ Medicaid programs, including Georgia, to implement regulated care settings to installed program recipients. This agreement resolves charges of accounting trick, falsification of documents also other reports, including quantity manipulation, and administration of the group of broadcasted beneficiaries by selective marketing and similar misconduct.
Below the Agreement, WellCare accepted to pay the participating States and the United States $137.5 million, plus interest, in four sections over a term not to exceed three years. Georgia Medicaid’s share of the arrangement is $33 million in the country and federal dollars. Medicaid is funded collectively by the federal and federal governments.
As a component of the agreement, WellCare has begun into a Corporate Integrity
Agreement with the Office of Inspector General of the Department of Health and Human Services. This Charter provides for ongoing overlooking of the corporation’s reconstruction for three years.
The probe included five whistleblower lawsuits filed under the quidam requirements of the Federal and certain State False Claims Act. These actions are pending in the United States District Court for the District of Connecticut, the Middle District of Florida, and the State of Florida Second Circuit.
March of 2011, there is also an illegal element to this case. Five former executives were indicted with connivance to charge Medicaid fraud and making false statements. This is an extension to a report and plea agreement by a former executive entered into in 2009.
The investigation and following raid arose from allegations that WellCare dishonestly and fraudulently increased payment data submitted to the Florida Medicaid and Healthy Kids programs from mid-2002 through 2006 and this is the possible criminal charges in Wellcare fraud.
Based on a research these are the DPA requirements that Wellcare needs to avoid healthcare fraud conviction,
- Complying to the civil forfeiture of $40 million, as well as an additional payment of $40 million in compensation to the Florida Medicaid and Healthy Kids programs
- Recalling and paying an independent monitor, chosen by the U.S. Attorney’s Office, who will review and monitor sales operations
- Proceeding to cooperate with the government’s open-ended federal and state criminal investigation of former WellCare executives and employees
- Performing, within 60 days, renewed policies and systems to guarantee accurate reports of federal and state healthcare plan information.
- Spreading to develop and operate an efficient corporate agreement and governance details that involves adequate internal controls to prevent recurrence of any improper or illegal activities
WellCare Health Plans. Inc. declared that it will pay approximately $194 million to resolve a class-action protection lawsuit that arose from a 2007 fraud investigation. According to insurer settlement purposes all litigation arising from the four-year-old investigation and—connected with additional state and federal lawsuits and fines— bumps the total remuneration costs in the last 15 months to about $427.5 million.
By July 31, 2021, WellCare will make cash payments of $52.5 million within 30 days of approval, and $35 million. WellCare’s command gives the plaintiffs tradable unsecured debentures as a face value of $112.5 million, with a settled coupon of 6%, and a maximum maturity dated Dec. 31, 2016.
A shareholder class-action lawsuit was filed in U.S. District Court in Florida Friday by the New Orleans law firm Kahn Gauthier Swick against WellCare. The Year 2006 the day officials from the Federal Bureau of Investigation, the U.S. Health and Human Services Department and the Florida Attorney General’s Medicaid fraud-control member raided WellCare’s offices.
The lawsuit declares the company defrauded investors on profits statements filed during that time frame, given the raids that took place.
Eastwood Enterprises, a WellCare shareholder, is listed as the primary plaintiff. WellCare executives did not respond to phone calls asking comments, however, the company said it was making a designated committee of the board to watch developments in the investigations and supervise the response to them. Executives commanded in a prepared report that transactions proceeded as normal.
According to Todd S. Farha WellCare’s chairman and chief executive in a press release, “We continue to respond to Wednesday’s developments in a direct, prompt, and orderly manner,”
“We remain committed to cooperating with the government throughout this process,” he added.
