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

Healthcare Auditing Weekly, May 12, 2009

On May 5, Tampa-based WellCare Health Plans, Inc. agreed to enter a deferred prosecution agreement (DPA) with the United States Department of Justice (DOJ) and pay $80 million in restitution and forfeiture in order to avoid healthcare fraud charges.

After an ongoing 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 press 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 healthcare fraud conviction, WellCare must abide by several DPA requirements, including:

• Consenting to the civil forfeiture of $40 million, as well as an additional payment of $40 million in restitution to the Florida Medicaid and Healthy Kids programs
• Retaining and paying an independent monitor, selected by the U.S. Attorney’s Office, who will review and monitor business operations
• Continuing to cooperate with the government’s ongoing federal and state criminal investigation of former WellCare executives and employees
• Implementing, within 60 days, updated policies and procedures to ensure accurate reports of federal and state healthcare program information
• Continuing to develop and operate an effective corporate compliance and governance program that includes adequate internal controls to prevent recurrence of any improper or illegal activities

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