Business Crimes Hotline

Specifically, the settlement announced on April 3 resolves four whistleblower lawsuits filed pursuant to the qui tam provisions of the FCA. The qui tam suits alleged multiple schemes involving Medicare and Medicaid, including retention of overpayments and falsification of data. According to the government's release, Wellcare provides managed health care services for roughly 2.6 million beneficiaries of these programs across the country.

As part of the settlement, the four whistleblowers ' referred to as “relators” under the FCA ' received $25.41 million of the settlement, with over 80% of that total allocated to a former Wellcare financial analyst, as the analyst's lawsuit triggered the government's investigation. The remainder of the settlement will be split among the United States and nine separate states.

In announcing the settlement, Stuart F. Delery, Acting Assistant Attorney General for the Justice Department's Civil Division, made the following comments: “Government health plans increasingly rely on managed care organizations to provide patient care. This case illustrates our commitment to ensur[ing] that government funds are in fact used to render care and not to line the pockets of those more concerned with the bottom line.”

Additionally, Robert E. O'Neill, U.S. Attorney for the Middle District of Florida, had the following to say about the settlement: “The monies recovered in restitution and from this settlement agreement will go to the federal and state programs which suffered these losses, while the forfeited funds will go to law enforcement to help fund future investigations,” adding that “[i]n an era of decreasing federal and state budgets, and increasing healthcare costs, we must pursue all available civil remedies to recover losses suffered by government healthcare programs. This settlement should serve as notice to those defrauding state and federal healthcare programs that, in addition to appropriate criminal prosecutions, we will utilize civil suits to root out their conduct and recover their ill-gotten gains.”

FLORIDA

Second Government FCA Settlement Brings Total Government Recoveries to $217.5 Million

On April 3, the Department of Justice (DOJ) announced a second False Claims Act (FCA) settlement ' totaling $137.5 million ' with Tampa, FL-based Wellcare Health Plans Inc. (Wellcare), arising from the government's criminal and civil investigation of Wellcare that commenced in 2006. The government's earlier Wellcare settlement, in the form of a Deferred Prosecution Agreement that included restitution and forfeiture commitments totaling $80 million, was concluded on May 5, 2009.

Specifically, the settlement announced on April 3 resolves four whistleblower lawsuits filed pursuant to the qui tam provisions of the FCA. The qui tam suits alleged multiple schemes involving Medicare and Medicaid, including retention of overpayments and falsification of data. According to the government's release, Wellcare provides managed health care services for roughly 2.6 million beneficiaries of these programs across the country.

As part of the settlement, the four whistleblowers ' referred to as “relators” under the FCA ' received $25.41 million of the settlement, with over 80% of that total allocated to a former Wellcare financial analyst, as the analyst's lawsuit triggered the government's investigation. The remainder of the settlement will be split among the United States and nine separate states.

In announcing the settlement, Stuart F. Delery, Acting Assistant Attorney General for the Justice Department's Civil Division, made the following comments: “Government health plans increasingly rely on managed care organizations to provide patient care. This case illustrates our commitment to ensur[ing] that government funds are in fact used to render care and not to line the pockets of those more concerned with the bottom line.”

Additionally, Robert E. O'Neill, U.S. Attorney for the Middle District of Florida, had the following to say about the settlement: “The monies recovered in restitution and from this settlement agreement will go to the federal and state programs which suffered these losses, while the forfeited funds will go to law enforcement to help fund future investigations,” adding that “[i]n an era of decreasing federal and state budgets, and increasing healthcare costs, we must pursue all available civil remedies to recover losses suffered by government healthcare programs. This settlement should serve as notice to those defrauding state and federal healthcare programs that, in addition to appropriate criminal prosecutions, we will utilize civil suits to root out their conduct and recover their ill-gotten gains.”