Under the Deferred Prosecution Agreement (DPA), WellCare agreed to pay $40 million in restitution. The company also agreed to forfeit additional $40 million to the U.S. government. It also agreed to cooperate with the government’s criminal investigation.
In April 2012, WellCare also settled four lawsuits alleging violations of the False Claims Act. The company agreed to pay $137.5 million to the federal government and nine state states. The lawsuits claimed that WellCare submitted inflated expenditures on medical care to avoid returning funds to Medicaid programs.
In addition, the company allegedly engaged in marketing abuses including “cherry picking” healthy patients to avoid future costs. Furthermore, the lawsuits claimed that WellCare manipulated its call center performance metrics and operated a sham special investigations unit.
According to the DOJ, the FBI, HHS-OIG, and the Florida AG’s Medicaid Fraud Control United investigated this case.
