WellCare

WellCare Health Plans, Inc. began operations in 1985 and is based in Tampa, Florida. WellCare provides Medicare and Medicaid managed care health plans for over 4 million members, partners with over 91,000 physicians, and employs over 6,000 associates. Wellcare Health Plans, Inc. is the holding company for several subsidiaries, including WellCare, Staywell, HealthEase, Harmony, and 'Ohana. Regional offices are located in Miami, Florida; Manhattan, New York; New Haven, Connecticut; Baton Rouge, Louisiana; Marietta, Georgia; Houston, Texas; and Chicago, Illinois.^[1]

History

Wellcare began operations in 1985 in Tampa, FL, as a Medicaid provider for the State of Florida. With the passage of the Balanced Budget Act of 1997, WellCare began offering Medicare beneficiaries private health insurance plans. These programs were known as Medicare+Choice or Part C plans. In 2003, WellCare began offering Medicare Advantage plans with prescription drug benefits after the signing of the Medicare Prescription Drug, Improvement, and Modernization Act. In 2006, Wellcare began offering Medicare Medicare Part D plans and has since become one of the top 10 Part D insurance providers by membership volume for these types of plans.

On October 24, 2007, law enforcement agents from the Federal Bureau of Investigation, Department of Health and Human Services, and the Florida Attorney General's Medicaid Fraud Control Unit executed a search warrant on the premises of WellCare Health Plans' headquarters in Tampa, FL. Trading on WellCare's stock was halted on the news but subsequently fell as low as 80% below the 52-week high.^[2] The U.S. Securities and Exchange Commission (SEC) has WellCare's financials under watch and several class-action lawsuits were launched against WellCare on behalf of shareholders. WellCare has said that its normal business operations have not been affected by the federal and state investigations, and that it remains financially sound, with over $1 billion in cash and cash equivalents.

In a now-unsealed plea agreement, prosecutors and a former employee said the company inflated expenditures by submitting fake documents to the state. Under some mental health care contracts, WellCare was paid a flat per-patient fee and required to spend at least 80 percent of it on care. Any leftover amount beyond 20 percent was to be repaid to the state, but the bogus expenditures allowed WellCare to keep that surplus. WellCare agreed in August to repay $35 million, its best estimate of the total wrongly kept from 2002-2006. After the raid, the company restated its quarterly and annual profits, driving down net income by $32 million, and saw its top three executives resign. No criminal charges have been announced against WellCare or its officials but investigations by Florida, Connecticut, and federal prosecutors are ongoing. The Securities and Exchange Commission is leading an informal investigation, and Wellcare faces numerous shareholder lawsuits and sealed whistleblower complaints, the company's SEC filings say. WellCare has since halted all Florida campaign contributions.^[3]

Acquisitions

Since late 2012, WellCare has acquired many smaller Medicare & Medicaid supplement providers that has significantly expanded the company's national coverage areas:

• November, 2012: Easy Choice Health Plan in California^[4]

• February, 2013: UnitedHealthcare's Medicaid business in South Carolina^[5]

• April, 2013: Missouri Care, Incorporated^[6]

• September, 2013: Purchase of Windsor Health Group (primarily in Mississippi, Tennessee, Arkansas, and South Carolina) was announced, anticipated to be completed in FQ4, 2013.^[7]

References

External links

• Corporate web site
• CMS official web site at cms.hhs.gov
• Medicare Is Signed Into Law page from ssa.gov — material about the bill-signing ceremony
• Historical Background and Development of Social Security from ssa.gov — includes information about Medicare
• Detailed Chronology of SSA from ssa.gov — includes information about Medicare
• Early Medicare poster from ssa.gov