Corporate Compliance

Florida health plan company enters $80M agreement to avoid fraud charges

Compliance Monitor, May 13, 2009

On May 5, Tampa-based WellCare Health Plans, Inc. agreed to enter a deferred prosecution agreement (DPA) with the Department of Justice (DOJ) and pay $80 million in restitution and forfeiture to avoid healthcare fraud charges.
After an investigation, more than 200 special agents and investigators from the FBI, OIG, and the Florida Medicaid Fraud Control Unit raided WellCare offices, according to a DOJ release.
The investigation and subsequent raid arose from allegations that WellCare falsely and fraudulently inflated expenditure information submitted to the Florida Medicaid and Healthy Kids programs from mid-2002 through 2006.
In order to avoid a healthcare fraud conviction, WellCare must abide by several DPA requirements, including:
  • Paying a civil forfeiture of $40 million
  • Paying an additional $40 million in restitution to the Florida Medicaid and Healthy Kids programs
  • Retaining and paying an independent monitor to review and monitor business operations
  • Cooperating with the government’s ongoing federal and state criminal investigation of former WellCare executives and employees
  • Implementing updated policies and procedures to ensure accurate reports of federal and state healthcare program information
  • Developing and operating an effective corporate compliance and governance program  

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