INDIANAPOLIS – The State of Indiana will receive more than $922,000 in a settlement that managed-care provider WellCare Health Plans Inc. reached with nine states and the federal government this week to resolve allegations of fraud against the Medicaid program.

An HMO based in Tampa, Florida, WellCare has agreed to pay $137.5 million in four installments over three years to the federal government, Indiana and eight other states. The Indiana Medicaid program's share of the settlement is $922,099.67 and the recovery will be used to fund future investigations of fraud against Medicaid, the state-and-federal health care program for low-income people.

The agreement with WellCare settles five lawsuits brought against the company by four whistleblowers who filed suit on behalf of the government under the False Claims Act. The lawsuits alleged that WellCare participated in various schemes to submit false claims to Medicaid, including allegations of accounting fraud, falsification of records and manipulation of data involving covered recipients, according to the U.S. Department of Justice (DOJ). The whistleblowers, called "relators," will receive a percentage of the settlement collectively totaling approximately $25 million, DOJ said. None of the whistleblowers are from Indiana. 

"The False Claims Act is a powerful legal tool in federal and state law that allows whistleblowers to expose illegal conduct, stop fraud against government contracts and potentially receive a portion of any monetary recovery for their time and trouble. Too often we see defendants attempting to overbill or fraudulently bill the Medicaid program, and this settlement illustrates the financial consequences if companies violate the law and defraud the taxpayers," Indiana Attorney General Greg Zoeller said.

The Indiana Medicaid Fraud Control Unit (MFCU), which is part of the Attorney General's Office, participated with other states and the DOJ in the lawsuit settlement negotiations with WellCare.

Since January 2009, the Indiana Attorney General's Office has joined in 17 previous settlements of whistleblower lawsuits, all with pharmaceutical companies, that resulted in more than $26 million in recovery to the Indiana Medicaid program.

Zoeller and deputy attorneys general at MFCU also have led presentations to groups of health care workers to educate them about their legal right to bring whistleblower lawsuits – called qui tam lawsuits – under the False Claims Act, as part of a public-awareness effort called "Blow the Whistle on Fraud."

Members of the public who want to learn more about whistleblower lawsuits or report suspected Medicaid fraud can find more information at this link:

http://www.in.gov/attorneygeneral/2807.htm

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