WellCare Settles with Whistleblowers

A successful settlement in a whistle-blower case against health insurance company WellCare is now final.  It will result in a $137.5 million payment to the federal government.  The James Hoyer Law Firm represented one of four whistle-blowers in the case.

James Hoyer client Clark Bolton was Supervisor of WellCare’s Special Investigations Unit and came forward to the government to help expose wrongdoing by the company. Bolton alleged the insurer encouraged over-billing and refused to audit claims for fraud in order to gain favor with doctors and hospitals and build market share. WellCare has acknowledged it overcharged Florida and Illinois health programs by about $46.5 million.

The investigation first became public in 2007, when federal agents raided the company’s headquarters in Tampa. In March of last year, five former executives of WellCare Health were indicted on charges of fraud by United States Attorney Robert E. O’Neill for the Middle District of Florida.

This settlement resolves inquiries which were pending before the Civil Division of the United States Department of Justice and the United States Attorneys’ Offices for the Middle District of Florida and the District of Connecticut.

The deal was reached in 2010, but delayed due to the objection of one of the the whistle-blowers.  That objection was recently withdrawn, making it possible to finalize the deal.  Under terms of the settlement, WellCare will pay the $137.5 million plus interest to the federal government over 3 years.  A percentage of that recovery will be divided among the four whistle-blowers who came forward to expose the problem.

WellCare Health Plans, Inc. provides managed care services targeted to government-sponsored health care programs, focusing on Medicaid and Medicare.  The company is headquartered in Tampa, Florida.