National health insurer WellCare Health Plans has resolved a federal and state investigation into alleged Medicaid fraud.
The insurer said as part of the agreement with the U.S. Attorney’s Office and the Florida State’s Attorney’s Office, a one-count charge of conspiracy to commit health care fraud against the Florida Medicaid and Healthy Kids programs under certain contracts will be suspended, pending court approval.
WellCare will pay a total of $80 million; $35.2 million of that amount was paid last August. WellCare will pay $25 million more as soon as a judge approves the deal, and the remaining $19.8 million by the end of this year.
In return, prosecutors will essentially place WellCare on probation for between two years and three years.
“We are pleased to have reached this resolution,” said Heath Schiesser, president and chief executive officer of WellCare, in a statement.
He said the company has responded to the allegations with the development of “a comprehensive compliance program that will provide a solid foundation for WellCare’s future.”
Charles G. Berg, executive chairman of WellCare, added, “The company has cooperated fully in these matters and the board of directors is very pleased that they have been resolved. Compliance with all of the laws and regulations governing WellCare’s business is a top priority, not only for our senior leadership team, but for all of our associates.”
WellCare must retain an independent monitor, chosen by the U.S. Attorney’s Office, for 18 months.
WellCare said it is cooperating fully and engaged in resolution discussions with the Civil Division of the United States Department of Justice, the Office of Inspector General of the U.S. Department of Health and Human Services (OIG), and the U.S. Securities and Exchange Commission.


Regional news: 









