According to a Securities and Exchange Commission filing, WellCare Health Plans has agreed to pay $137.5 million to settle a False Claims Act qui tam action, claiming that the Medicare and Medicaid contractor stole $400 million to $600 million from government health care programs in several states. The whistleblower alleges that the company avoided paying back overpayments it received from State Medicaid programs, inflated reinsurance payments, and improperly sought to disenroll Medicaid beneficiaries whom the company considered unprofitable. Most of the allegations involve violations of the FCA “reverse false claims” provision, which attaches liability to those who fail to return money owed to the federal government.
This is the latest in a long line of recent WellCare settlements. In May 2009, facing a criminal indictment, WellCare agreed to pay $40 million in restitution and a $40 million forfeiture to the federal government to avoid criminal prosecution on four charges that it inflated its billings to the Florida Medicaid program. In a separate agreement with the Securities and Exchange Commission, WellCare agreed to pay a $10 million fine.