The U.S. Department of Justice has announced Tampa, Fla.-based WellCare Health Plan will pay $137.5 million to the federal government and nine states to settle four lawsuits alleging the payor violated the False Claims Act.
The suits claim WellCare committed a number of schemes to submit false claims to Medicare and Medicaid programs. Allegations include WellCare inflating the amount it claimed to spend on medical care, knowingly retaining overpayments it received from Florida Medicaid for infant care and falsifying data to misrepresent patient conditions and treatments.
The $137.5 million settlement will be divided among the federal government and nine states: Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York and Ohio. Sean Hellein, a financial analyst formerly employed by WellCare whose qui tam complaint initiated the federal investigation, will receive approximately $20.75 million.
Editor's note: This article was modified April 5 to correct the mistaken inclusion of WellPoint.
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The suits claim WellCare committed a number of schemes to submit false claims to Medicare and Medicaid programs. Allegations include WellCare inflating the amount it claimed to spend on medical care, knowingly retaining overpayments it received from Florida Medicaid for infant care and falsifying data to misrepresent patient conditions and treatments.
The $137.5 million settlement will be divided among the federal government and nine states: Connecticut, Florida, Georgia, Hawaii, Illinois, Indiana, Missouri, New York and Ohio. Sean Hellein, a financial analyst formerly employed by WellCare whose qui tam complaint initiated the federal investigation, will receive approximately $20.75 million.
Editor's note: This article was modified April 5 to correct the mistaken inclusion of WellPoint.
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