Stanford University Law School - Securities Class Action Clearinghouse



                 UNITED STATES DISTRICT COURT

                NORTHERN DISTRICT OF NEW YORK
___________________________________
                                   )
GRANT K. WARD, on behalf of        )
himself and all others similarly   )
situated,                          )  CASE NO. 96-CV-0521
                                   )
                    Plaintiff,     )  CLASS ACTION COMPLAINT
                                   )  FOR VIOLATIONS OF
                                   )  FEDERAL SECURITIES LAWS
               v.                  )
                                   )
THE WELLCARE MANAGEMENT GROUP,     )
INC.; EDWARD A. ULLMANN; and       )
MARYSTEPHANIE CORSONES,            )  JURY TRIAL DEMANDED
                                   )
                    Defendants.    )
___________________________________)


          Plaintiff makes the following allegations upon 

information and belief, except as to allegations specifically 

pertaining to the plaintiff and his counsel, based on the facts 

alleged below, which are predicated upon a review by forensic 

accountants and the investigation undertaken by plaintiff's 

counsel, which investigation included analyses of publicly- 

available news articles (including reliable investigative 

reports), public filings, releases, and other matters of public 

record.  Plaintiff believes that further substantial evidentiary 




support will exist for the allegations set forth below after a reasonable opportunity for discovery. NATURE OF THE ACTION 1. This is a class action on behalf of all persons who purchased the common stock of The WellCare Management Group, Inc. ("WMG" or the "Company") between August 2, 1994 and March 18, 1996, inclusive (the "Class Period"), seeking to pursue remedies under the Securities Exchange Act of 1934 (the "Exchange Act"). As hereinafter alleged, during the Class Period, WMG, a managed health care holding company, and the two Individual Defendants, each of whom is an executive officer, director and controlling person of WMG, knowingly or recklessly misrepresented the financial condition and performance of the Company. Defendants' fraudulent scheme and deceptive course of business artificially inflated and maintained the trading price of WMG common stock during the Class Period and thereby injured plaintiff and other purchasers of WMG stock. By misportraying the Company's financial results, defendants drove the price of WMG common stock, which was initially offered to the public in August 1993 at a price of $11.75 per share, to a Class Period high of $37 per share (the closing price on March 27, 1995). Per share earnings reported by the Company rose from $0.52 in 1992 to $1.25 in 1995. 2. Notwithstanding defendants' efforts to conceal their misconduct, the truth about WMG's financial condition and performance finally began to leak to the public on or about - 2 -
March 16, 1996, when Barron's, a prominent national financial publication, published a report -- based on, among other things, an examination of internal Company documents and interviews with Company employees -- detailing a series of "unusual transactions [that] have inflated the HMO's profits since coming public." During a week of extremely heavy trading following the publication of the Barron's report, the price of WMG stock plummeted in value by $7.25 per share -- or more than 30% -- to close at $16.50 on March 22, 1996. JURISDICTION AND VENUE 3. This Court has jurisdiction over the subject matter of this action pursuant to 28 U.S.C. §§ 1331 and 1337, and Section 27 of the Exchange Act (15 U.S.C. § 78aa). 4. This action arises under Sections 10(b) and 20(a) of the Exchange Act and Rule 10b-5 promulgated thereunder (17 C.F.R. § 240.10b-5). 5. Venue is proper in this District pursuant to Sec- tion 27 of the Exchange Act and 28 U.S.C. § 1391(b). WMG has its corporate headquarters in this District at Park West/Hurley Avenue Extension, Kingston, New York, and the acts charged herein, including the preparation and dissemination of materially false and misleading information, occurred in substantial part in this District. 6. In connection with the acts alleged in this com- plaint, the defendants, directly or indirectly, used the means and instrumentalities of interstate commerce, including, but not - 3 -
limited to, the mails, interstate telephone communications, and the facilities of the national securities markets. PARTIES 7. Plaintiff Grant K. Ward purchased 200 shares of WMG common stock during the Class Period on June 26, 1995, at a price of $22.75 per share (excluding fees, charges and commissions), and was damaged thereby. 8. (a) Defendant WMG is a corporation organized and existing under the laws of the State of New York. The Company's principal executive offices are located at Park West/Hurley Avenue Extension, Kingston, New York. WMG is a managed health care holding company. Its wholly-owned subsidiary WellCare of New York, Inc. ("WCNY") is a direct contract independent practice association ("IPA") model health maintenance organization ("HMO"). An HMO is an organization that accepts contractual responsibility for the delivery of a stated range of health care services to its enrollees for a predetermined, prepaid fee. As a direct contract IPA model HMO, WCNY enters into agreements with physician groups and individual primary care physicians or practices for the provision of all medical care to WCNY's enrollees for a specified monthly payment ("capitation fee"). WCNY provides comprehensive health care services to members in the Hudson River Valley, Mohawk River Valley, Albany, and Leatherstocking regions of New York State through a provider network consisting of approximately 500 primary care physicians, 1,000 specialists, and 24 hospitals. Another wholly-owned - 4 -
subsidiary, WellCare of Connecticut, Inc., operates as an HMO in the State of Connecticut. Through other wholly-owned subsidiaries, WMG also provides specialty benefit programs and related administrative services to employer and other groups that utilize health care services, and administrative and management services to physician practices. (b) WMG first issued shares to the public, pursuant to an initial public offering, in or about August 1993 at a price of $11.75 per share. At all times relevant to this action, the common stock of WMG was actively traded on the NASDAQ National Market System, a national securities exchange, under the ticker symbol "WELL" and was registered pursuant to Section 12 of the Exchange Act (15 U.S.C. § 78e). The market for WMG common stock was therefore open, well-developed and efficient at all relevant times. WMG files annual, quarterly and other reports with the Securities and Exchange Commission (the "SEC") in accordance with the Exchange Act. (c) As of November 1, 1995, the Company had outstanding more than 4.8 million shares of common stock and approximately 1.5 million shares of Class A common stock. The Class A common stock and the common stock are identical in all respects except for voting rights, conversion rights, and the non-transferability of the Class A common stock. Holders of Class A common stock are entitled to ten votes per share and holders of common stock to one vote per share. Class A common stock is not transferable and must be converted to common stock to be sold. Holders of Class A common stock may, at their - 5 -
option, convert their shares to common stock on a share-for-share basis. 9. Defendant Edward A. Ullmann founded WMG in 1983 and since then has served as its Chairman, President and Chief Executive Officer, capacities in which he has received substantial compensation. Defendant Ullmann's employment agreement with the Company provides for an annual bonus equal to two percent of the Company's net profits (up to a maximum of $200,000 per annum), and such additional bonus as the Board of Directors may determine. As of April 20, 1995, Ullmann was the beneficial owner of at least 763,610 shares of WMG Class A common stock, representing 49% of all such shares outstanding, and 6,500 shares of WMG common stock, and thereby controlled approximately 38% of the total voting power within the Company. Defendant Ullmann signed each of the Form 10-K and 10-Q reports filed by the Company during the Class Period, as the "principal executive officer" of the Company. 10. Defendant Marystephanie Corsones joined the Company in July 1993 as Finance Director and since May 1994 has served as its Chief Financial Officer and Vice President of Finance, capacities in which she has received substantial compensation. Defendant Corsones also has been a member of the Company's Board of Directors since November 1994 and was during the Class Period a member of the Audit Committee of the Board, which meets with the Company's outside auditors to review the scope of their annual audit, the adequacy of the Company's system of internal controls, and the sufficiency of its financial - 6 -
reporting. Defendant Corsones's employment agreement with the Company provides for an annual bonus equal to one-half percent of the Company's net profits (with an annual maximum amount of $35,000), and such additional bonus as the Board of Directors or the Company's President may determine. According to the Company's Form 10-K report for the fiscal year ended December 31, 1994 (the "1994 10-K"), Corsones has more than ten years' experience in international finance and taxation and was senior director of U.S. International Operations at the "big-six" accounting firm of Coopers & Lybrand for more than five years. Corsones is therefore knowledgeable and experienced concerning financial and accounting matters. Defendant Corsones signed each of the Form 10-K and 10-Q reports filed by the Company during the Class Period, as the "principal financial and accounting officer" of the Company. 11. The individual defendants identified above are sometimes referred to herein collectively as the "Individual Defendants." 12. It is appropriate to treat the Individual Defendants as a group for pleading purposes and to presume that the false and misleading information conveyed in the Company's financial statements, public filings, press releases and other publications as alleged herein are the collective actions of the narrowly defined group of defendants identified above. Each of the above officers and directors of WMG, by virtue of his or her high-level positions with the Company, directly participated in the management of the Company, was directly involved in the day- - 7 -
to-day operations of the Company at the highest levels, and was privy to confidential proprietary information concerning the Company and its operations, finances, financial condition, performance and results as alleged herein. Said defendants were involved in drafting, producing, reviewing and/or disseminating the false and misleading statements alleged herein, were aware that false and misleading statements were being issued regarding the Company and approved or ratified these statements, in violation of the federal securities laws. 13. As officers, directors and controlling persons of a publicly-held company whose common stock was, and is, registered with the SEC pursuant to the Exchange Act, traded on the NASDAQ National Market System, and governed by the provisions of the federal securities laws, the Individual Defendants each had a duty to disseminate promptly accurate and truthful information with respect to the Company's financial condition, performance, results, operations, business, products, markets, management, earnings, and business prospects, and to correct any previously-issued statements that had become materially misleading or untrue, so that the market price of the Company's publicly-traded securities would be based upon truthful and accurate information. The Individual Defendants' mis- representations during the Class Period violated these specific requirements and obligations. 14. The Individual Defendants participated in the drafting, preparation, and/or approval of the various financial statements, and public and shareholder and investor reports and - 8 -
other communications complained of herein and were aware of or recklessly disregarded the misstatements contained therein and omissions therefrom, and were aware of their materially false and misleading nature. Because of their Board membership and executive and managerial positions with WMG, each of the Individual Defendants had access to the adverse non-public information about WMG's financial condition and performance as particularized herein and knew that these adverse facts rendered the positive representations made by and about WMG and its business and the financial statements issued by the Company materially false and misleading. 15. The Individual Defendants, because of their positions of control and authority as officers and directors of the Company, were able to and did control the contents of the various quarterly and annual financial reports, press releases and other public statements pertaining to the Company. Each Individual Defendant was provided with copies of the financial statements and documents alleged herein to be false and misleading prior to or shortly after their issuance and had the ability and opportunity to prevent their issuance or to cause them to be corrected. Accordingly, each of the Individual Defendants is responsible for the accuracy of the financial statements and public reports and releases detailed herein and is therefore primarily liable for the representations contained therein. 16. Each of the defendants is liable as a participant in a fraudulent scheme and course of business that operated as a - 9 -
fraud and deceit on purchasers of WMG stock, by disseminating materially false and misleading statements and/or concealing material, adverse facts. The scheme: (i) deceived the investing public regarding WMG's business, its financial condition and performance, and the intrinsic value of WMG shares; and (ii) caused plaintiff and other members of the Class to purchase WMG stock at artificially inflated prices. PLAINTIFF'S CLASS ACTION ALLEGATIONS 17. Plaintiff brings this action as a class action pursuant to Federal Rule of Civil Procedure 23(a) and (b)(3) on behalf of a Class consisting of all persons who purchased or otherwise acquired shares of WMG common stock from August 2, 1994 through March 18, 1996, inclusive (the "Class Period"), and who were damaged thereby. Excluded from the Class are defendants, members of the immediate family of each of the Individual Defendants, any subsidiary or affiliate of WMG and the directors, officers and employees thereof, any entity in which any excluded person has a controlling interest, and the legal representatives, heirs, successors and assigns of any excluded person. 18. The members of the Class are so numerous that joinder of all members is impracticable. While the exact number of Class members is unknown to plaintiff at this time and can only be ascertained through appropriate discovery, plaintiff believes that there are thousands of members of the Class located throughout the United States. As of November 1, 1995, there were more than 4.8 million shares of WMG common stock outstanding. - 10 -
Throughout the Class Period, WMG common stock was actively traded on the NASDAQ National Market System. Record owners and other members of the Class may be identified from records maintained by WMG and/or its transfer agent and may be notified of the pendency of this action by mail, using a form of notice similar to that customarily used in securities class actions. 19. Plaintiff's claims are typical of the claims of the other members of the Class as all members of the Class were similarly affected by defendants' wrongful conduct in violation of federal law that is complained of herein. 20. Plaintiff will fairly and adequately protect the interests of the members of the Class and has retained counsel competent and experienced in class and securities litigation. 21. Common questions of law and fact exist as to all members of the Class and predominate over any questions solely affecting individual members of the Class. Among the questions of law and fact common to the Class are: (a) Whether the federal securities laws were vio- lated by defendants' acts and omissions as alleged herein; (b) Whether defendants participated in and pursued the common course of conduct complained of herein; (c) Whether documents, press releases, public filings, and other statements disseminated to the investing public and the Company's shareholders during the Class Period misrepresented material facts about the business, financial condition and performance of WMG; - 11 -
(d) Whether statements made by defendants to the investing public during the Class Period misrepresented material facts about the business, financial condition and performance of WMG; (e) Whether the market price of WMG's common stock during the Class Period was artificially inflated due to the material misrepresentations and failures to correct the material misrepresentations complained of herein; and (f) To what extent the members of the Class have sustained damages and the proper measure of damages. 22. A class action is superior to all other available methods for the fair and efficient adjudication of this contro- versy since joinder of all members is impracticable. Further- more, as the damages suffered by individual Class members may be relatively small, the expense and burden of individual litigation make it impossible for members of the Class to individually redress the wrongs done to them. There will be no difficulty in the management of this suit as a class action. SUBSTANTIVE ALLEGATIONS APPLICABILITY OF PRESUMPTION OF RELIANCE: FRAUD-ON-THE-MARKET DOCTRINE 23. At all relevant times, the market for WMG common stock was an efficient market for the following reasons, among others: (a) WMG common stock met the requirements for listing, and was listed and actively traded, on the NASDAQ National Market System, a highly efficient and automated market; - 12 -
(b) As a regulated issuer, WMG filed periodic public reports with the SEC and the NASD; and (c) WMG was followed by securities analysts employed by major brokerage firms who wrote reports which were distributed to the sales force and certain customers of their respective brokerage firms. Each of these reports was publicly available and entered the public marketplace. Among the securities firms that followed the Company during the Class Period were: A. G. Edwards; Advest Group; Furman Selz; Hambrecht & Quist; Ladenburg, Thalmann; Merrill Lynch; Morgan Stanley & Co.; Robertson Stephens & Co.; Smith Barney; and Vector Securities International. 24. As a result, the market for WMG securities promptly digested current information with respect to WMG from all publicly-available sources and reflected such information in WMG's stock price. Under these circumstances, all purchasers of WMG shares during the Class Period suffered similar injury through their purchase of shares at artificially inflated prices and a presumption of reliance applies. MATERIALLY AND FALSE MISLEADING STATEMENTS AND OMISSIONS 25. The Class Period begins on August 2, 1994, the day the Company issued a press release purporting to report financial results for the second quarter of 1994, the first fiscal quarter during which improprieties specified in the Barron's investigative report occurred. In its press release of August 2, 1994, the Company reported total revenue of $29,707,000 and net - 13 -
income of $1,466,000, or $0.24 per share, for the quarter. The Company also reported total assets of $55,422,000, liabilities of $26,999,000, and shareholders' equity of $28,423,000, as of June 30, 1994. The August 2 press release stressed that WMG provides "cost-effective comprehensive health care services. . . ." As an HMO, WMG's ability to control the costs associated with providing health care coverage to its HMO members is critical to its success as an enterprise and to the valuation of the Company by the marketplace. 26. On or about August 4, 1994, the Company filed its Form 10-Q report for the quarterly period ended June 30, 1994 (the "Second Quarter 1994 10-Q") with the SEC. The Second Quarter 1994 10-Q was signed by each of the Individual Defendants. The 10-Q reiterated the purported financial results announced by the Company on or about August 2. In the notes to the financial statements, defendants represented that: In the opinion of management, the accompanying unaudited interim financial statements contain all adjustments necessary to present fairly the financial position at June 30, 1994, and the results of operations and cash flows for the interim periods presented. 27. On or about November 1, 1994, the Company issued a press release purporting to report financial results for the third quarter of 1994. The Company reported total revenue of $31,021,000 and net income of $1,561,000, or $0.25 per share, for the quarter. The Company also reported total assets of $55,972,000, total liabilities of $25,902,000, and shareholders' equity of $30,070,000, as of September 30, 1994. - 14 -
28. On or about November 11, 1994, the Company filed its Form 10-Q report for the quarterly period ended September 30, 1994 (the "Third Quarter 1994 10-Q") with the SEC. The Third Quarter 1994 10-Q was signed by each of the Individual Defendants. The 10-Q reiterated the purported financial results announced by the Company on or about November 1. In the notes to the financial statements, defendants represented that: In the opinion of management, the accompanying unaudited interim financial statements contain all adjustments (consisting only of normal recurring adjustments) necessary to present fairly the financial position at September 30, 1994, and the results of operations and cash flows for the interim periods presented. 29. On or about February 14, 1995, the Company issued a press release purporting to report financial results for the quarter and full year ended December 31, 1994. The Company reported total revenue of $31,831,000 and net income of $1,956,000, or $0.31 per share, for the quarter and total revenue of $121,770,000 and net income of $6,238,000, or $1.00 per share, for the full year, as compared to total revenue of $75.9 million and net income of $0.72 per share (before the cumulative effect of a change in accounting for income taxes) for 1993. The Company also reported total assets of $55,876,000, liabilities of $23,790,000, and shareholders' equity of $32,086,000, as of December 31, 1994. The press release quoted defendant Ullmann as stating: 1994 was a year of investment as WellCare prepared for the growth we anticipate through increased penetration in our current service area and through geographic and product - 15 -
expansions. With the failure of national health care reform, WellCare is prepared to take advantage of the tremendous opportunities that are emerging for cost- effective health care companies in the private sector. (Emphasis added.) The February 14 press release reiterated that WMG "currently provides cost-effective comprehensive health care services. . . ." 30. On or about March 30, 1995, the Company filed its 1994 10-K with the SEC. The 1994 10-K was signed by each of the Individual Defendants, among other persons. The Company reported total revenue of $32,643,000 and net income of $1,956,000, or $0.31 per share, for the fourth quarter of 1994 and total revenue of $122,582,000 and net income of $6,238,000, or $1.00 per share, for the full year 1994. The Company also reported total assets of $55,674,000, liabilities of $23,587,000, and shareholders' equity of $32,087,000, as of December 31, 1994. With regard to the Company's purported cost-effectiveness, the 10-K stated: The Company's success depends to a significant degree upon its ability to control health care costs. WellCare controls such costs through (i) capitation arrangements with the Alliances [physician groups] and with non-Alliance primary care physicians, (ii) discounted fee arrangements with non-Alliance specialists and other health care providers (other than hospitals which are paid on a DRG basis in New York State), (iii) health care utilization review programs, (iv) preventive care education for its members and participating physicians, (v) quality of care programs and (vi) co-payments by members for office visits and other services. Notwithstanding such cost control measures, certain factors, such as regulatory changes, epidemics and natural disasters, which impact health care costs, are beyond the Company's control and may adversely affect its operations. - 16 -
31. On or about May 8, 1995, the Company issued its 1994 Annual Report to shareholders. The 1994 Annual Report reiterated the purported financial results for 1994 reported in the 1994 10-K. The Letter to Shareholders, which appeared at the beginning of the 1994 Annual Report, contained, among others, the following positive statements touting the Company's purported financial success: 1994 was a year of innovation, unprecedented growth and preparation for future growth. * * * While the fortunes of HMOs ebbed and flowed in the uncertain investment market in 1994, WellCare kept focused on the business of providing high quality health care in the most cost-effective way possible. As a result, WellCare ended the year with record profits. Net income for the year was $6.2 million or approximately $1 per share compared to $3.6 million or $0.72 per share before cumulative effect of a change in accounting principle for 1993. WellCare's excellent financial performance, growth and innovative leadership in health care established it as a solid investment opportunity, and WellCare attracted the attention of major investment analysts and media in 1994. USA Today highlighted WellCare as one of the top IPOs in the nation, and a Fortune magazine cover feature story listed WellCare among "America's 100 Fastest Growing Companies." Investor's Business Daily featured WellCare as a public company presenting an excellent investment opportunity. Among analyst firms to issue buy recommendations for WellCare stock in 1994 were A.G. Edwards & Sons, Inc., Smith Barney, Inc., Robertson Stephens & Company and Punk Ziegel and Knoell. Their recommendations proved out as WellCare achieved the significant revenue, growth and membership projections of the investment community. - 17 -
And on a personal note, it was WellCare's excellent performance as a company that earned for me the title "Health Care Entrepreneur of the Year in the Southern New England Region" in the 1994 national "Entrepreneur of the Year" competition sponsored by Inc. magazine, Merrill Lynch, and Ernst and Young. * * * By every measure, 1994 was a year of vigorous growth for WellCare. (Emphasis added.) The Letter to Shareholders was signed by defendant Ullmann. The 1994 Annual Report further touted WMG's purported cost-effectiveness, noting, among other things, that "[a]t WellCare, cost-effectiveness and quality are woven into the fabric of care." 32. On or about May 9, 1995, the Company issued a press release purporting to report financial results for the first quarter of 1995. The Company reported total revenue of $34,875,000 and net income of $1,602,000,or $0.26 per share, for the quarter. The Company also reported total assets of $62,771,000, liabilities of $28,882,000, and shareholders' equity of $33,889,000, as of March 31, 1995. The press release quoted defendant Ullmann as stating: "The first quarter was one of dramatic progress for WellCare, both in terms of geographic and program expansion." The May 9 press release also stressed that WMG "currently provides cost-effective comprehensive health care services. . . ." 33. On or about May 12, 1995, the Company filed its Form 10-Q for the quarterly period ended March 31, 1995 (the "First Quarter 1995 10-Q") with the SEC. The First Quarter 1995 - 18 -
10-Q was signed by each of the Individual Defendants. The 10-Q reiterated the purported financial results announced by the Company on or about May 9. In the notes to the financial statements, defendants represented that: In the opinion of management, the accompanying unaudited interim financial statements contain all adjustments (consisting of only normal recurring adjustments) necessary to present fairly the financial position at March 31, 1995, and the results of operations and cash flows for the interim periods presented. 34. On or about August 7, 1955, the Company issued a press release purporting to report financial results for the second quarter of 1995. The Company reported total revenue of $36,902,000 and net income of $1,762,000, or $0.28 per share, for the quarter. The Company also reported total assets of $68,999,000, liabilities of $33,301,000, and shareholders' equity of $35,698,000, as of June 30, 1995. 35. On or about August 11, 1995, the Company filed its Form 10-Q report for the quarterly period ended June 30, 1995 (the "Second Quarter 1995 10-Q") with the SEC. The Second Quarter 1995 10-Q was signed by each of the Individual Defendants. The 10-Q reiterated the purported financial results announced by the Company on or about August 7. In the notes to the financial statements, defendants represented that: In the opinion of management, the accompanying unaudited interim financial statements contain all adjustments necessary to present fairly the financial position at June 30, 1995, and the results of operations and cash flows for the interim periods presented. - 19 -
36. On or about November 7, 1995, the Company issued a press release purporting to report financial results for the third quarter of 1995. The Company reported total revenue of $40,112,000 and net income of $2,069,000, or $0.33 per share, for the quarter. The Company also reported total assets of $69,684,000, liabilities of $31,727,000, and shareholders' equity of $37,957,000, as of September 30, 1995. 37. On or about November 13, 1995, the Company filed its Form 10-Q report for the quarterly period ended September 30, 1995 (the "Third Quarter 1995 10-Q") with the SEC. The Third Quarter 1995 10-Q was signed by each of the Individual Defendants. The 10-Q reiterated the purported financial results announced by the Company on or about November 7. In the notes to the financial statements, defendants represented that: In the opinion of management, the accompanying unaudited interim financial statements contain all adjustments necessary to present fairly the financial position at September 30, 1995, and the results of operations and cash flows for the interim periods presented. 38. On or about February 14, 1996, the Company issued a press release purporting to report financial results for the quarter and full year ended December 31, 1995. The Company reported total revenue of $44,324,000 and net income of $2,381,000, or $0.38 per share, for the quarter and total revenue of $156,213,000 and net income of $7,814,000 or $1.25 per share, for the full year (as compared to total revenue of $122,582,000 and net income of $6,238,000, or $1.00 per share, for 1994). The Company also reported total assets of $76,392,000, liabilities of - 20 -
$35,672,000, and shareholders' equity of $40,720,000, as of December 31, 1995. The press release quoted defendant Ullmann as stating: We are very pleased with the results for 1995. It was a great year for us financially and in terms of product innovation, operational growth and geographic expansion. . . . In 1995, we substantially advanced WellCare's vision for health care, and we look forward to seeing the fruits of our labors into the 21st Century. The February 14 press release again stated that WMG "currently provides cost-effective comprehensive health care services. . . ." THE TRUTH BEGINS TO EMERGE 39. One month later, on or about Saturday, March 16, 1996, Barron's published an article entitled "WellCare Management Group: Conflicting Accounts," which concluded -- based on an examination of internal Company documents apparently in the possession of a Kingston, New York radiologist who had done business with the Company (and which were then sent on to the Company's outside auditors by the doctor), review of records of an ongoing New York State Insurance Department investigation of WMG, and interviews with WellCare employees -- that "various unusual transactions have inflated the HMO's profits since coming public." (A copy of the Barron's report is attached hereto as Exhibit A.) Barron's reported that WMG had hired the private investigative firm of Kroll Associates to determine who at the Company had leaked the internal records. The Barron's article - 21 -
detailed "a series of odd transactions" during the years 1994 and 1995 including the following: (a) On April 5, 1994, defendant Ullmann issued a memo to Catskill Medical Associates ("Catskill Medical"), an independent medical practice for which a WMG subsidiary did administrative work but which was not part of WMG, instructing it to send checks on its own account totaling over $100,000 to more than a dozen doctors to whom WMG owed money. Barron's reported that Ullmann's orders "puzzled" WMG employees because none of the doctors had contracts with Catskill Medical. "According to WellCare computer records," some of the claims Ullmann wanted paid off even had dates of service predating the incorporation of Catskill Medical in September 1993. (b) Catskill Medical sent money directly to WMG itself. On May 13, 1994, the President of Catskill Medical, Dr. Randall Rissman, who also has ties with WMG (and whose photograph is featured prominently in the Company's 1994 Annual Report), wrote WMG a $250,000 check drawn on Catskill Medical's account. As the Barron's report noted, this "seemed strange since funds generally flow from an HMO to doctors, not the other way around." (c) On or about June 27, 1994 -- just days before the end of the second quarter of the year -- a stack of 40 checks to WMG, totaling approximately $1.5 million, were received. (Significantly, reported net income for the second quarter of 1994 was only $1.466 million.) The checks were hard-to-trace bank checks from two upstate New York banks, Key Bank of New York and First National Bank of Rhinebeck. Both banks do business - 22 -
with WMG. Each check was made payable to WCNY "on behalf of" various doctors who did some business with the HMO. As bank checks, the drafts would leave no record of the drawer in the checking accounts of WMG. According to Barron's, defendant Corsones, "told curious employees that the doctors were repaying deficits they owed to WellCare." Barron's reported however that several doctors whose names appear on the bank checks informed it that they had no such deficits with WCNY and had never known of the checks, let alone co-signed or otherwise authorized them. One doctor named on a bank check who purportedly was repaying WCNY more than $100,000 told Barron's, "I never got paid that much in a whole year . . . so how could I have that balance?" The Barron's report reprinted photographs of three of the bank checks, totaling approximately $380,000, dated June 27 and 30, 1994. (d) Barron's also reported that, although the Company's 1994 10-K reported that 1994 medical expenses were reduced by the recovery of $2.7 million from doctors with deficits in their accounts with WMG, "WellCare employees say the real sources of the money that reduced the HMO's 1994 medical expenses were bank lines of credit taken out by doctors associated with outfits like Catskill Medical." According to Barron's, later in 1994, the money began to flow back from WMG to the doctors' groups "in an unusual way." In less than a week's time, WMG wrote three checks totaling nearly $1 million to Catskill Medical, with one check as large as $741,716.64. The check stubs called the payments "enhanced capitation." - 23 -
(e) WMG's statutory filings with the New York State Insurance Department report a $10.9 million asset called "other receivables -- net." In a December 1995 response to insurance examiners' request that the Company detail the asset, Ullmann explained that the largest portion of the "other receivables" was some $4.5 million purportedly owed WMG by hospitals for "medical advances." This item, according to Barron's, represented over a quarter of WCNY's statutory net worth. Yet, Barron's reported that when it inquired of officials at the hospitals listed on WMG's September 1995 account as owing large amounts, they disputed the entries, saying instead that WMG owed the hospitals money. For example, Horton Medical Center in Middletown, New York advised Barron's that instead of it owing WMG $63,901.70 in September 1995, as WMG claimed to the Insurance Department, the HMO owed the hospital more than ten times that amount in unpaid inpatient and outpatient claims. (f) Doctors also told of claims checks they received from WMG on which the Company identified no specific claim in the "explanation of benefits," but rather called the payment an "advance." By characterizing the payment of a claim as an advance defendants avoided incurring an expense and thereby improperly inflated reported income. The mischaracterization of medical expenses as advances also improperly inflated the Company's reported assets and net worth. 40. As a direct and immediate result of the stunning revelations contained in the Barron's report, the price of WMG stock fell. On Monday, March 18, 1996 -- the first trading day - 24 -
after the release of the Barron's report -- the trading price of WMG common stock dropped by $2.75 per share, or almost 12%, from the previous trading day's closing price of $23.75 per share to close at $21 per share, after trading as low as $17.75. The trading volume that day of 757,500 shares was more than seven times the three-month daily average of approximately 106,000 shares. After March 18, the trading price of WMG common stock continued to fall on unusually heavy volume, closing at $16.50 on March 22, 1996 -- a decline of $7.25 per share, or more than 30%, from the closing price on March 15, 1996, and a drop of $20.50 per share, or more than 55%, from the Class Period high closing price of $37. In the wake of the Barron's report, federal and state investigators have been making inquiries of Company personnel. In addition, the Company reportedly is in consultation with its outside auditor with respect to its 1994 financial statements. 41. The market for WMG common stock was open, well- developed and efficient at all relevant times. As a result of these materially false and misleading statements and failures to disclose the full truth about WMG and its financial condition, performance, and business, WMG common stock traded at artificially inflated prices during the entire Class Period, reaching a Class Period high closing price of $37 per share, until the time the adverse information referred to above was finally provided to and digested by the securities markets. Plaintiff and other members of the Class purchased or otherwise acquired WMG securities relying upon the integrity of the market - 25 -
price of WMG stock and market information relating to WMG, or in the alternative, upon defendants' false and misleading statements, and in ignorance of the adverse, undisclosed information known to defendants, and have been damaged thereby. Those who sold their shares during the Class Period were not able to fully recoup their out-of-pocket losses and damages. 42. During the Class Period, defendants materially misled the investing public, thereby inflating the price of WMG stock, by publicly issuing false and misleading statements, including false financial statements for the Company, and omitting to disclose material facts necessary to make defendants' statements, as set forth herein, not false and misleading. The documents and statements referred to in paragraphs 25 through 38 above, as well as others disseminated by defendants during the Class Period, were materially false and misleading in that, among other things: (a) Defendants engaged in deceptive transactions which lacked a valid business purpose and were designed to and did, among other things, inflate the reported profits of the Company. Such deceptive transactions included, among other things: (i) Defendant Ullmann's ordering a company with ties to WMG, Catskill Medical, to make payments to doctors to whom WMG owed money thereby reducing WMG's expenses; (ii) The receipt of checks from doctors at Catskill Medical, which has ties to WMG; - 26 -
(iii) The receipt, in the last days of the second quarter of 1994, of mysterious, hard-to-trace bank checks, and the effort by defendant Corsones to deceive suspicious employees at WMG by telling them that the bank checks were issued on behalf of doctors who purportedly were repaying "deficits" they owed to the Company when in truth at least several of the doctors whose names appeared on the checks owed no money to the Company and had never authorized the checks; (iv) The use of borrowed monies to reduce medical expenses and thereby inflate profits; (v) The recording of fictitious receivables; and (vi) The mischaracterization of medical expenses as advances thereby improperly inflating reported profits and net worth. (b) Defendants misportrayed the Company's financial results, among other things, reporting profits that were improperly inflated by means of various deceptive devices as heretofore alleged; (c) Defendants falsely represented that the Company's financial statements contained all adjustments necessary to present fairly the financial position of the Company and the results of operations and cash flows, when, in fact, the Company's public financial statements did not fairly or accurately report the Company's true financial results but instead distorted and misportrayed the financial condition and performance of the Company; - 27 -
(d) Defendants repeatedly stressed that WMG purportedly provides "cost effective" health care services, when, in fact, reported medical expenses had been improperly reduced by means of various deceptive devices, as alleged herein; and (e) Defendants failed to disclose that the Company's reported financial results did not comply with Generally Accepted Accounting Principles ("GAAP"), as required. 43. The Company's reported financial results violated at least the following provisions of GAAP, with which the Company was, and is, required to comply because of its status as a reporting company under the Exchange Act: (a) The principle that expenses should be recognized upon recognition of revenues that result directly and jointly from the same transactions or other events as the expenses was violated (FASB Statement of Concepts No. 5, ¶ 86); (b) The mischaracterization of medical expenses as advances violated the definition of "assets" embodied in FASB Statement of Concepts No. 6, ¶¶ 25-33; (c) The principle that financial reporting should provide information that is useful to present and potential investors and creditors and other users in making rational investment, credit and similar decisions was violated (FASB Statement of Concepts No. 1, ¶ 34); (d) The principle that financial reporting should provide information about an enterprise's financial performance during a period was violated. Investors and creditors often use information about the past to help in assessing the prospects of - 28 -
an enterprise. Thus, although investment and credit decisions reflect investors' expectations about future enterprise performance, those expectations are commonly based at least partly on evaluations of past enterprise performance (FASB Statement of Concepts No. 1, ¶ 42); (e) The principle that financial reporting should be reliable in that it represents what it purports to represent was violated. That information should be reliable as well as relevant is a notion that is central to accounting (FASB Statement of Concepts No. 2, ¶¶ 58-59); (f) The principle of completeness, which means that nothing material is left out of the information that may be necessary to ensure that it validly represents underlying events and conditions, was violated (FASB Statement of Concepts No. 2, ¶ 79); and (g) The principle that conservatism be used as a prudent reaction to uncertainty to try to ensure that uncertainties and risks inherent in business situations are adequately considered was violated. The best way to avoid injury to investors is to try to ensure that what is reported represents what it purports to represent (FASB Statement of Concepts No. 2, ¶¶ 95, 97). 44. At all relevant times, the material misrepresentations and omissions particularized in this Complaint directly or proximately caused or were a substantial contributing cause of the damages sustained by plaintiff and other members of the Class. As described herein, during the Class Period, - 29 -
defendants made or caused to be made a series of false and misleading statements about WMG's business, financial condition, results and performance. These material misstatements and omissions had the cause and effect of creating in the market an unrealistically positive assessment of WMG, and its business, financial condition, and performance, thus causing the Company's securities to be overvalued and artificially inflated at all relevant times. Defendants' false portrayal during the Class Period of WMG, and its financial condition and performance, resulted in plaintiff and other members of the Class purchasing the Company's securities at a disparity between their market price and their actual value, thus causing the damages complained of herein, both to persons who bought and held until the end of the Class Period as well as persons who bought and sold within that time. SCIENTER ALLEGATIONS 45. The manipulative and deceptive transactions alleged herein were ones which the Individual Defendants caused or permitted. Among other things, as heretofore alleged, the Individual Defendants ordered a company with ties to WMG make payments to doctors to whom WMG owed money, were aware that checks were received by WMG from doctors and others with ties to the Company, and acted to conceal from suspicious employees the improper purpose of such payments to the Company. 46. Defendants also acted with scienter in that defendants knew that the public documents and statements, - 30 -
including the financial statements, issued or disseminated in the name of the Company were materially false and misleading; knew or recklessly disregarded that such statements or documents would be issued or disseminated to the investing public; and knowingly and substantially participated or acquiesced in the issuance or dissemination of such statements or documents as primary violators of the federal securities laws. As set forth elsewhere herein in detail, defendants, by virtue of their receipt of information reflecting the true facts regarding WMG, their control over and/or receipt of WMG's materially misleading misstatements herein alleged and/or their associations with the Company which made them privy to confidential proprietary information concerning WMG, participated in the fraudulent scheme described herein. Defendants knew and/or recklessly disregarded the falsity and misleading nature of the information which they caused to be disseminated to the investing public. This case does not involve allegations of false forward-looking statements or projections but instead involves false financial statements and false statements of financial condition and results. 47. The Individual Defendants engaged in such a scheme to inflate the price of WMG securities in order, among other things, to: (i) protect and enhance their executive positions and the substantial compensation and prestige they obtained thereby; and (ii) enhance the value of their substantial personal holdings of WMG securities and options to acquire such securities. - 31 -
FIRST CLAIM (Violations of Section 10(b) Of The Exchange Act And Rule 10b-5 Promulgated Thereunder) 48. Plaintiff repeats and realleges the allegations set forth above as though fully set forth herein. This claim is asserted against all defendants. 49. During the Class Period, defendants, and each of them, carried out a plan, scheme and course of conduct which was intended to and, throughout the Class Period, did: (i) deceive the investing public, including plaintiff and other Class members, as alleged herein; (ii) artificially inflate and the market price of WMG securities; and (iii) cause plaintiff and other members of the Class to purchase WMG securi- ties at artificially inflated prices. In furtherance of this unlawful scheme, plan and course of conduct, defendants, and each of them, took the actions set forth herein. 50. Defendants (a) employed devices, schemes, and artifices to defraud; (b) made untrue statements of material fact and/or omitted to state material facts necessary to make the statements not misleading; and (c) engaged in acts, practices, and a course of business which operated as a fraud and deceit upon the purchasers of the Company's stock in an effort to maintain artificially high market prices for WMG's securities in violation of Section 10(b) of the Exchange Act and Rule 10b-5. All defendants are sued as primary participants in the wrongful and illegal conduct charged herein. The Individual Defendants also are sued as controlling persons of WMG, as alleged below. - 32 -
51. In addition to the duties of full disclosure imposed on defendants as a result of their making of affirmative statements and reports, or participation in the making of affirmative statements and reports to the investing public, the Individual Defendants had a duty to promptly disseminate truthful information that would be material to investors in compliance with the integrated disclosure provisions of the SEC as embodied in SEC Regulations S-X (17 C.F.R. § 210.01 et seq.) and S-K (17 C.F.R. § 229.10 et seq.) and other SEC regulations, including accurate and truthful information with respect to the Company's business, operations, financial condition and performance so that the market price of the Company's common stock would be based on truthful, complete and accurate information. 52. WMG and the Individual Defendants, individually and in concert, directly and indirectly, by the use of means or instrumentalities of interstate commerce and/or of the mails, engaged and participated in a continuous course of conduct to misrepresent and to conceal adverse material information concerning the business, financial condition, performance, and operations of WMG as specified herein. WMG and the Individual Defendants employed devices, schemes and artifices to defraud, while in possession of material adverse non-public information, and engaged in acts, practices, and a course of conduct as alleged herein in an effort to assure investors of WMG's value and performance and continued substantial growth, which included the making of, or the participation in the making of, untrue statements of material facts and omitting to state material facts - 33 -
necessary in order to make the statements made about WMG and its business, operations, financial condition, performance, and results in the light of the circumstances under which they were made, not misleading, as set forth more particularly herein, and engaged in transactions, practices and a course of business which operated as a fraud and deceit upon the purchasers of WMG securities during the Class Period. 53. Each of the Individual Defendants' primary liability, and controlling person liability, arises from the following facts, among others: (i) each of the Individual Defendants was a high-level executive and director at the Company during the Class Period and was a member of the Company's management team; (ii) each of the Individual Defendants, by virtue of his or her responsibilities and activities as a senior executive officer and director of the Company, was privy to and participated in the preparation of the Company's financial statements and reporting of the Company's financial condition and performance; (iii) the Individual Defendants enjoyed significant personal contact and familiarity with each other and were advised of and had access to other members of the Company's management team, internal reports, and other data and information about the Company's financial condition and performance at all relevant times; and (iv) the Individual Defendants were aware of the Company's dissemination of information to the investing public which they knew or recklessly disregarded was materially false and misleading. The manipulative and deceptive transactions alleged herein were ones which the Individual Defendants caused - 34 -
or permitted and for which they were thus responsible. The Individual Defendants had clear knowledge as to the suspicious nature and distorting effect of such transactions. 54. The defendants had actual knowledge of the misrepresentations and omissions of material facts set forth herein, or acted with reckless disregard for the truth in that they failed to ascertain and to disclose such facts, even though such facts were available to them. Such defendants' material misrepresentations and/or omissions were done knowingly or recklessly and for the purpose and effect of concealing WMG's true operating condition and performance from the investing public and supporting the artificially inflated price of its stock. As demonstrated by defendants' overstatements and misstatements of the Company's financial condition and performance throughout the Class Period, defendants, if they did not have actual knowledge of the misrepresentations and omissions alleged, were reckless in failing to obtain such knowledge by deliberately refraining from taking those steps necessary to discover whether those statements were false or misleading, and departed markedly from their fiduciary and full disclosure obligations and duties in connection therewith. 55. As a result of the dissemination of the materially false and misleading information and failure to disclose material facts, as set forth above, the market price of WMG common stock was artificially in inflated during the Class Period. In ignorance of the fact that the market price of WMG stock was artificially inflated, and relying directly or indirectly on the false and - 35 -
misleading statements made by defendants, or upon the integrity of the market in which the securities trade, and the truth of any representations made to appropriate agencies or to the investing public, at the times at which any statements were made, and/or on the absence of material adverse information that was known to or recklessly disregarded by defendants but not disclosed in public statements by defendants during the Class Period, plaintiff and the other members of the Class acquired WMG stock during the Class Period at artificially high prices and were damaged thereby. 56. At the time of said misrepresentations and omissions, plaintiffs and other members of the Class were ignorant of their falsity and believed them to be true. Had plaintiff and the other members of the Class and the marketplace known of the true financial condition and performance of WMG, which were not disclosed by defendants, plaintiff and other members of the Class would not have purchased or otherwise acquired their WMG shares during the Class Period, or, if they had acquired such securities during the Class Period, they would not have done so at the artificially inflated prices which they paid. 57. By virtue of the foregoing, defendants have violated Section 10(b) of the Exchange Act, and Rule 10b-5 promulgated thereunder. 58. As a direct and proximate result of defendants' wrongful conduct, plaintiff and the other members of the Class - 36 -
suffered damages in connection with their purchases of the Company's securities during the Class Period. SECOND CLAIM (Violations of Section 20(a) Of The Exchange Act Against The Individual Defendants) 59. Plaintiff repeats and realleges the allegations set forth above as if set forth fully herein. This claim is asserted against the Individual Defendants. 60. The Individual Defendants acted as controlling persons of WMG within the meaning of Section 20(a) of the Exchange Act as alleged herein. By virtue of their high-level positions, share ownership, participation in and/or awareness of the Company's operations and/or intimate knowledge of the Company's business, financial condition, and performance, the Individual Defendants had the power to influence and control and did influence and control, directly or indirectly, the decision- making of the Company, including the content and dissemination of the various statements that plaintiff contends are false and mis- leading. Each of the Individual Defendants was provided with or had unlimited access to copies of the Company's financial statements, reports, press releases, public filings and other statements alleged by plaintiff to be false and misleading prior to and/or shortly after these statements were issued and had the ability to prevent the issuance of the statements or cause the statements to be corrected. 61. Each of the Individual Defendants had direct involvement in the day-to-day operations of the Company and - 37 -
therefore, is presumed to have had the power to control or influ- ence the particular transactions giving rise to the securities violations as alleged herein, and exercised the same. 62. Pursuant to Section 20(a) of the Exchange Act, by virtue of their positions as controlling persons, the Individual Defendants are liable jointly and severally with and to the same extent as the Company for the Company's aforesaid violations of Section 10(b) of the Exchange Act and Rule 10b-5 promulgated thereunder. As a direct and proximate result of defendants' wrongful conduct, plaintiff and other members of the Class suffered damages in connection with their purchases of the Company's securities during the Class Period. WHEREFORE, plaintiff prays for relief and judgment, as follows: (a) Determining that this action is a proper class action under Rule 23 of the Federal Rules of Civil Procedure, and certifying plaintiff as class representative and his counsel as class counsel; (b) Awarding compensatory damages in favor of plaintiff and the other Class members against all defendants, jointly and severally, for all damages sustained as a result of defendants' wrongdoing, in an amount to be proven at trial, including interest thereon; (c) Awarding plaintiff and the Class their reasonable costs and expenses incurred in this action, including counsel fees and expert fees; and - 38 -
(d) Such other and further relief as the Court may deem just and proper. JURY TRIAL DEMANDED Plaintiff hereby demands a trial by jury. DATED: March 29, 1996 WHITEMAN OSTERMAN & HANNA /s/ By: ___________________________ Leslie M. Apple BAR Roll No. 104216 1 Commerce Plaza Suite 1900 Albany, NY 12260 (518) 487-7600 - and - MILBERG WEISS BERSHAD HYNES & LERACH LLP /s/ By: ___________________________ David J. Bershad Robert P. Sugarman Steven G. Schulman Richard H. Weiss One Pennsylvania Plaza 49th Floor New York, NY 10119 (212) 594-5300 Attorneys for Plaintiff - 39 -
[Attachment: March 18, 1996 Barron's article, "WellCare Management Group: Conflicting Accounts," by Bill Alpert.]
UNITED STATES DISTRICT COURT NORTHERN DISTRICT OF NEW YORK ___________________________________ ) GRANT K. WARD, on behalf of ) himself and all others similarly ) situated, ) CASE NO. ) Plaintiff, ) ) ) v. ) ) THE WELLCARE MANAGEMENT GROUP, ) INC.; EDWARD A. ULLMANN; and ) MARYSTEPHANIE CORSONES, ) ) Defendants. ) ___________________________________) CERTIFICATION OF GRANT K. WARD IN SUPPORT OF CLASS ACTION COMPLAINT GRANT K. WARD ("plaintiff") declares, as to the claims asserted under the federal securities laws, that: 1. Plaintiff has reviewed the complaint prepared by counsel in the above-captioned case and has authorized its filing. 2. Plaintiff did not purchase the security that is the subject of the complaint at the direction of plaintiff's counsel or in order to participate in any private action arising under the federal securities laws. 3. Plaintiff is willing to serve as a representative party on behalf of a class, including providing testimony at deposition and trial, if necessary.
4. During the proposed Class Period, plaintiff executed the following transactions relating to the common stock of The WellCare Management Group, Inc.: Date Action Amount Price 6/26/95 Bought 200 shares $22.75 1/9/96 Sold 200 shares $18.25 5. In the past three years, plaintiff has not filed any other action under the federal securities laws in which he has sought to serve as a representative party on behalf of a class. 6. Plaintiff will not accept any payment for serving as a representative party on behalf of a class beyond plaintiff's pro rata share of any recovery, except such reasonable costs and expenses (including lost wages) directly relating to the representation of the Class as ordered or approved by the Court. I declare under penalty of perjury that the foregoing is true and correct. Executed this 26 day of March, 1996. /s/ ________________________________ Grant K. Ward - 2 -
3 Aug 1997