Tampa, Fla.-based WellCare Health Plans has agreed to a $10 million settlement with the U.S. Securities and Exchange, regarding an informal investigation into its financial filings.
WellCare agreed to the final judgment, without admitting or denying the allegations against it, including a permanent injunction against any future violations of certain provisions of the federal securities laws, according to the SEC. The insurer must make the first $2.5 million payment of the settlement in 30 days.
The SEC settlement comes just over two weeks after WellCare resolved a federal and state investigation into alleged Medicaid fraud, reaching an agreement with the U.S. Attorney’s Office and the Florida State’s Attorney Office. In that matter, a one-count charge of conspiracy to commit health care fraud against the Florida Medicaid and Healthy Kids programs under certain contracts was suspended, pending court approval. The insurer also agreed to pay $80 million as part of the settlement.
In the new settlement, the SEC alleged that from November 2003 to October 2007, WellCare fraudulently kept nearly $40 million it was required to return to Florida agencies for programs providing health care services to uninsured children and mental health services to Medicaid recipients. WellCare therefore overstated its net income through retaining the funds.
WellCare “executed its scheme by intentionally underpaying refunds it owed to” the Florida Agency for Health Care Administration and the Florida Healthy Kids program, the SEC said. Retaining the funds also inflated the insurer’s earnings per share by 9% to 14% from 2004 to 2007.
In July 2008, upon the recommendation of its board of directors, WellCare restated certain previously issued consolidated financial statements, the SEC said. The restatements related to accounting errors identified with respect to compliance with refund requirements in certain contracts.
WellCare is now current in its financial reporting, including filings with the SEC.
Thomas F. O’Neil III, senior vice president and general counsel of WellCare, said the company is “pleased that this matter has been resolved.”
“From the outset, WellCare cooperated fully with the SEC, and we are committed to enterprise-wide regulatory compliance and ethical business practices,” O’Neil said in a statement.


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