WellCare

WellCare Health Plans, Inc.

Type	Public
Traded as	NYSE: WCG
Founded	Tampa, Florida (1985)
Headquarters	Tampa, Florida, United States
Key people	Ken Burdick (CEO) David Gallitano (Executive chairman)
Services	Healthcare
Website	http://www.wellcare.com

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.

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. 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.

In the nearly 10 years following the FBI raid, WellCare has instated numerous trainings, practices, and ethical standards to maintain vertical transparency and ensure that the highest of standards are upheld, even where the law lacks, in order to place emphasis on the members and their care. The public perception of the company lingers in the past, but the reality is that WellCare and it's associates are not those of 2007.

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

• February, 2013: UnitedHealthcare's Medicaid business in South Carolina

• April, 2013: Missouri Care, Incorporated

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

Benefits assessment

On November 16, 2007, HealthMetrix Research selected WellCare as a 2008 Senior Choice Gold Award recipient for its Medicare Advantage benefits plan. Recipients were selected from over 200 Medicare managed care plans based on cost-sharing comparisons including out-of-pocket costs in the areas of co-payments, deductibles and premiums. HealthMetrix Research Inc., a national independent managed care research firm, conducted its comparisons in over 120 cities across the United States in October 2007. Medicare Advantage plans were compared based on out-of-pocket costs for beneficiaries based on health status categories and corresponding utilization of the most common plan benefits such as physician office visits, emergency or urgent care, hospital care, prevention care and prescriptions. The comparisons identified the Medicare plans with the lowest and highest estimated annual out-of-pocket costs based on the approved 2008 member co-payments, deductibles and premiums that appear in the Medicare Options Compare database.

HealthMetrix Research awarded WellCare best overall value in the design of its 2008 medical and prescription drug benefits for seniors in the following 21 markets:

• Fort Lauderdale, Florida
• Savannah, Georgia
• Essex County, New Jersey
• Hudson County, New Jersey
• Passaic County, New Jersey
• Union County, New Jersey
• Buffalo, New York
• Rochester, New York
• Akron-Canton, Ohio
• Cincinnati, Ohio
• Cleveland, Ohio
• Columbus, Ohio
• Champaign-Urbana, Illinois
• Chicago, Illinois
• Fort Wayne, Indiana
• Indianapolis, Indiana
• South Bend, Indiana
• Baton Rouge, Louisiana
• New Orleans, Louisiana
• Fort Worth, Texas
• San Antonio, Texas

Analyst coverage

See Yahoo! analyst coverage

• Fidel, Scott (Deutsche Bank)
• Mcdonald, Carl (Oppenheimer & Co.)
• Nersessian, Gregory (Credit Suisse First Boston)
• Borsch, Matthew (Goldman Sachs)

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