in july 2013 , our ohio subsidiary , buckeye community health plan ( buckeye ) , began operating under a new and expanded contract with ohio department of job and family services ( odjfs ) to serve medicaid members statewide through ohio 's three newly aligned regions ( west , central/southeast , and northeast ) . buckeye also began serving members under the abd children program in july 2013. tennessee . in september 2013 , our joint venture subsidiary , centurion , began operating under a new contract to provide comprehensive healthcare services to individuals incarcerated in tennessee state correctional facilities . texas . in march 2012 , we began operating under contracts in texas that expanded its operations through new service areas including the 10 county hidalgo service area and the medicaid rural service areas of west texas , central texas and north-east texas , as well as the addition of star+plus in the lubbock service area . the expansion also added the management of outpatient pharmacy benefits in all service areas and products , as well as inpatient facility services for the star+plus program . washington . in july 2012 , we began operating under a new contract with the washington health care authority to serve medicaid beneficiaries in the state , operating as coordinated care . we expect the following items to contribute to our future growth potential : we expect to realize the full year benefit in 2014 of business commenced during 2013 in california , florida , massachusetts , new hampshire , ohio , and tennessee as discussed above . in february 2014 , our mississippi subsidiary , magnolia health plan , was awarded a statewide managed care contract to continue serving members enrolled in the mississippi coordinated access network ( mississippican ) program , as one of two contractors . under the new contract , magnolia will continue providing outpatient , behavioral health , pharmacy , vision and dental services , and will also begin providing non-emergency transportation as of july 1 , 2014. in january 2014 , we acquired a majority interest in u.s. medical management , llc , a management services organization and provider of in-home health services for high acuity populations , for approximately $ 200.0 million . the transaction consideration was financed through a combination of cash on hand and 2,243,217 shares of centene common stock in january 2014 , we began serving members enrolled in health insurance marketplaces in certain regions of 9 states : arkansas , florida , georgia , indiana , massachusetts , mississippi , ohio , texas and washington . in january 2014 , our celticare subsidiary began operating under a new contract with the massachusetts executive office of health and human services to participate in the masshealth careplus program in all five regions . in january 2014 , centurion began operating under a new agreement with the minnesota department of corrections to provide managed healthcare services to offenders in the state 's correctional facilities . in december 2013 , we signed a definitive agreement to purchase a majority stake in fidelis securecare of michigan , inc. ( fidelis ) , a subsidiary of fidelis seniorcare , inc. the transaction is expected to close in the fourth quarter of 2014 , subject to certain closing conditions including regulatory approvals , and will involve cash purchase price payments contingent on the performance of the plan over the course of 2015. fidelis was recently selected by the michigan department of community health to provide integrated healthcare services to members who are dually eligible for medicare and medicaid in macomb and wayne counties . enrollment is expected to commence in the fourth quarter of 2014 . 33 in november 2013 , our south carolina subsidiary , absolute total care , was selected by the south carolina department of health and human services to serve dual-eligible members as part of the state 's pilot program to provide integrated and coordinated care for individuals who are eligible for both medicare and medicaid . operations are expected to commence in the second half of 2014. in september 2013 , the florida agency for health care administration provided notice of intent to award a contract to our subsidiary , sunshine health , in 9 of 11 regions of the managed medical assistance ( mma ) program . the mma program includes tanf recipients as well as abd and dual-eligible members . the award is subject to challenge and contract readiness periods , with enrollment expected to begin in the second quarter of 2014 and continue through october 2014. in addition , we were recommended as the sole provider under a contract award for the child welfare specialty plan ( foster care ) , which is expected to commence in the second quarter of 2014. in september 2013 , we were awarded a contract in texas from the texas health and human services commission to expand our operations and serve star+plus members in two medicaid rural service areas . enrollment is expected to begin in the second half of 2014. in november 2012 , our illinois subsidiary , illinicare health plan , was selected , contingent upon successful completion of contract negotiations , to serve dual-eligible members in cook , dupage , lake , kane , kankakee and will counties ( greater chicago region ) as part of the illinois medicare-medicaid alignment initiative . upon execution of a contract and regulatory approval , enrollment is expected to begin in 2014. in august 2012 , we were notified by the odjfs that buckeye , our ohio subsidiary , was selected to serve medicaid members in a dual-eligible demonstration program in three of ohio 's pre-determined seven regions : northeast ( cleveland ) , northwest ( toledo ) and west central ( dayton ) . story_separator_special_tag the year over year decrease in the g & a expense ratio reflects the leveraging of expenses over higher revenues in 2012 and a reduction in performance based compensation expense in 2012 which lowered the g & a expense ratio by approximately 60 basis points . impairment loss during 2011 , the company completed its annual goodwill and intangible asset impairment testing and concluded that the fair value of all reporting units with material amounts of goodwill was substantially in excess of the carrying value as of our impairment testing date . specifically , the company tested its celtic reporting unit under a quantitative model which included anticipated financial performance for new business to be converted in 2012. under the quantitative model , the testing revealed that the carrying value exceeded fair value of the celtic reporting unit by approximately 190 % . during 2012 , our subsidiary , celtic insurance company , experienced a high level of medical costs for individual health policies , especially for recently issued policies related to members converted from another insurer during the first quarter of 2012. additionally , in june 2012 , the u.s. supreme court upheld the constitutionality of the patient protection and affordable care act . the affordable care act , among other things , limits the profitability of the individual health insurance business because of minimum medical loss ratios , guaranteed issue policies , and increased competition in the marketplace product . as a result of these factors , our expectations for future growth and profitability were lower than previous estimates and we conducted an impairment analysis of the identifiable intangible assets and goodwill of the celtic reporting unit . the impairment analysis resulted in goodwill and intangible asset impairments of $ 28.0 million , recorded as an impairment loss in the consolidated statement of operations . the impaired identifiable intangible assets of $ 2.3 million and goodwill of $ 25.7 million were reported under the specialty services segment ; $ 26.6 million of the impairment loss is not deductible for income tax purposes . 41 investment and other income , net the following table summarizes the components of other income ( expense ) for the year ended december 31 , ( $ in millions ) : replace_table_token_13_th investment income . the increase in investment income in 2012 primarily reflects higher investment balances in 2012. gain on sale of investments . during the year ended december 31 , 2012 , we recognized $ 1.5 million in net gains primarily as a result of the liquidation of $ 75.5 million of investments held by the georgia health plan in order to meet short term liquidity needs due to delays in premium receipts from the state . gain on sale of investment in convertible note . between july 2008 and october 2011 , we made an investment of $ 30.0 million in secured notes receivable to a third party as part of an investment in certain medicaid and medicare related businesses . the notes included a feature to convert the note balance into an equity ownership in the underlying businesses . in september 2012 , we executed an agreement with the borrower whereby the borrower agreed to pay us total consideration of $ 50.0 million for retirement of the outstanding notes and equity ownership conversion feature . as a result , during the third quarter of 2012 , we recorded a pre-tax gain of $ 17.9 million in other income representing the fair value of the total consideration in excess of the carrying value of the loans on the balance sheet . interest expense . interest expense increased during the year ended december 31 , 2012 by $ 0.2 million reflecting the issuance of an additional $ 175 million in senior notes in november 2012 , partially offset by the refinancing of our $ 250 million senior notes and execution of the associated interest rate swap agreement in may 2011. income tax expense excluding the effects of noncontrolling interests , our effective tax rate for 2012 was 34.9 % compared to 37.0 % in 2011 . the tax rate for the year ended december 31 , 2012 , reflects a tax benefit resulting from the clarification by a state taxing authority regarding a state income tax calculation , partially offset by celtic 's non-deductible goodwill impairment . segment results the following table summarizes our operating results by segment for the year ended december 31 , ( in millions ) : replace_table_token_14_th managed care premium and service revenues increased 55.6 % in the year ended december 31 , 2012 , due to the addition of our illinois , louisiana , mississippi , missouri and washington contracts , texas expansion , pharmacy carve-ins in texas and ohio , and organic membership growth . earnings from operations decreased $ 99.0 million in the year ended december 31 , 2012 , 42 primarily due to higher medical costs in our texas health plan specifically in the expansion areas and increased flu costs during the fourth quarter of 2012. specialty services premium and service revenues increased 77.0 % in the year ended december 31 , 2012 , due to ( 1 ) the carve-in of pharmacy services in texas and ohio , ( 2 ) specialty company revenue related to the growth in our medicaid segment and the associated specialty services provided to this increased membership and ( 3 ) the arizona expansion . earnings from operations increased $ 3.2 million in the year ended december 31 , 2012 , reflecting growth in our pharmacy business and the associated specialty services provided to our increased medicaid membership , partially offset by the impairment loss of $ 28.0 million recorded in 2012 and a high level of medical costs in celtic insurance company , especially for members converted in the first quarter of 2012. liquidity and capital resources shown below is a condensed schedule of cash flows for the years ended december 31 , 2013 , 2012 and

cash flows from operating activities for 2013 increased $ 103.8 million , or 37 % compared to 2012 due to an increase in net earnings between years and growth in our business . additionally , incentive compensation accruals increased from 2012 due to the performance of the company . this accrual will be paid during the first and second quarter of 2014. cash flows from operating activities for 2012 increased $ 17.0 million , or 6 % compared to 2011 driven by lower net earnings that were partially offset by the growth in medical claims liabilities associated with business expansions . cash flows from operations in each year were impacted by the timing of payments we receive from our states . states may prepay the following month premium payment , which we record as unearned revenue , or they may delay our premium payment , which we record as a receivable . we typically receive capitation payments monthly , however the states in which we operate may decide to adjust their payment schedules which could positively or negatively impact our reported cash flows from operating activities in any given period . the table below details the impact to cash flows from operations from the timing of payments from our states ( $ in millions ) . replace_table_token_16_th net cash provided by operating activities in 2011 was negatively impacted by the timing of payments from our states by $ 120.4 million . as of december 31 , 2011 , we had received all december 2011 capitation payments from our states and had not received any prepayments of january 2012 capitation . this was offset by an increase in medical claims liabilities related to the start up of our mississippi , illinois and kentucky health plans , as well as expansion of our texas health plan in 2011. cash flows used in investing activities cash flows used in investing activities in 2013 primarily consisted of additions to the investment portfolio of our regulated subsidiaries , including transfers from cash and cash equivalents to long term investments , the acquisition of acariahealth and 43 capital expenditures .


 Write a concise suspicious activity report of the following text delimited by triple backquotes. Return your response as a formal report which covers the key points highlighting the location,dates,entity names and account holder information in chronological order of the text.
     ```cash flows from operating activities for 2013 increased $ 103.8 million , or 37 % compared to 2012 due to an increase in net earnings between years and growth in our business . additionally , incentive compensation accruals increased from 2012 due to the performance of the company . this accrual will be paid during the first and second quarter of 2014. cash flows from operating activities for 2012 increased $ 17.0 million , or 6 % compared to 2011 driven by lower net earnings that were partially offset by the growth in medical claims liabilities associated with business expansions . cash flows from operations in each year were impacted by the timing of payments we receive from our states . states may prepay the following month premium payment , which we record as unearned revenue , or they may delay our premium payment , which we record as a receivable . we typically receive capitation payments monthly , however the states in which we operate may decide to adjust their payment schedules which could positively or negatively impact our reported cash flows from operating activities in any given period . the table below details the impact to cash flows from operations from the timing of payments from our states ( $ in millions ) . replace_table_token_16_th net cash provided by operating activities in 2011 was negatively impacted by the timing of payments from our states by $ 120.4 million . as of december 31 , 2011 , we had received all december 2011 capitation payments from our states and had not received any prepayments of january 2012 capitation . this was offset by an increase in medical claims liabilities related to the start up of our mississippi , illinois and kentucky health plans , as well as expansion of our texas health plan in 2011. cash flows used in investing activities cash flows used in investing activities in 2013 primarily consisted of additions to the investment portfolio of our regulated subsidiaries , including transfers from cash and cash equivalents to long term investments , the acquisition of acariahealth and 43 capital expenditures .
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 Suspicious Activity Report : in july 2013 , our ohio subsidiary , buckeye community health plan ( buckeye ) , began operating under a new and expanded contract with ohio department of job and family services ( odjfs ) to serve medicaid members statewide through ohio 's three newly aligned regions ( west , central/southeast , and northeast ) . buckeye also began serving members under the abd children program in july 2013. tennessee . in september 2013 , our joint venture subsidiary , centurion , began operating under a new contract to provide comprehensive healthcare services to individuals incarcerated in tennessee state correctional facilities . texas . in march 2012 , we began operating under contracts in texas that expanded its operations through new service areas including the 10 county hidalgo service area and the medicaid rural service areas of west texas , central texas and north-east texas , as well as the addition of star+plus in the lubbock service area . the expansion also added the management of outpatient pharmacy benefits in all service areas and products , as well as inpatient facility services for the star+plus program . washington . in july 2012 , we began operating under a new contract with the washington health care authority to serve medicaid beneficiaries in the state , operating as coordinated care . we expect the following items to contribute to our future growth potential : we expect to realize the full year benefit in 2014 of business commenced during 2013 in california , florida , massachusetts , new hampshire , ohio , and tennessee as discussed above . in february 2014 , our mississippi subsidiary , magnolia health plan , was awarded a statewide managed care contract to continue serving members enrolled in the mississippi coordinated access network ( mississippican ) program , as one of two contractors . under the new contract , magnolia will continue providing outpatient , behavioral health , pharmacy , vision and dental services , and will also begin providing non-emergency transportation as of july 1 , 2014. in january 2014 , we acquired a majority interest in u.s. medical management , llc , a management services organization and provider of in-home health services for high acuity populations , for approximately $ 200.0 million . the transaction consideration was financed through a combination of cash on hand and 2,243,217 shares of centene common stock in january 2014 , we began serving members enrolled in health insurance marketplaces in certain regions of 9 states : arkansas , florida , georgia , indiana , massachusetts , mississippi , ohio , texas and washington . in january 2014 , our celticare subsidiary began operating under a new contract with the massachusetts executive office of health and human services to participate in the masshealth careplus program in all five regions . in january 2014 , centurion began operating under a new agreement with the minnesota department of corrections to provide managed healthcare services to offenders in the state 's correctional facilities . in december 2013 , we signed a definitive agreement to purchase a majority stake in fidelis securecare of michigan , inc. ( fidelis ) , a subsidiary of fidelis seniorcare , inc. the transaction is expected to close in the fourth quarter of 2014 , subject to certain closing conditions including regulatory approvals , and will involve cash purchase price payments contingent on the performance of the plan over the course of 2015. fidelis was recently selected by the michigan department of community health to provide integrated healthcare services to members who are dually eligible for medicare and medicaid in macomb and wayne counties . enrollment is expected to commence in the fourth quarter of 2014 . 33 in november 2013 , our south carolina subsidiary , absolute total care , was selected by the south carolina department of health and human services to serve dual-eligible members as part of the state 's pilot program to provide integrated and coordinated care for individuals who are eligible for both medicare and medicaid . operations are expected to commence in the second half of 2014. in september 2013 , the florida agency for health care administration provided notice of intent to award a contract to our subsidiary , sunshine health , in 9 of 11 regions of the managed medical assistance ( mma ) program . the mma program includes tanf recipients as well as abd and dual-eligible members . the award is subject to challenge and contract readiness periods , with enrollment expected to begin in the second quarter of 2014 and continue through october 2014. in addition , we were recommended as the sole provider under a contract award for the child welfare specialty plan ( foster care ) , which is expected to commence in the second quarter of 2014. in september 2013 , we were awarded a contract in texas from the texas health and human services commission to expand our operations and serve star+plus members in two medicaid rural service areas . enrollment is expected to begin in the second half of 2014. in november 2012 , our illinois subsidiary , illinicare health plan , was selected , contingent upon successful completion of contract negotiations , to serve dual-eligible members in cook , dupage , lake , kane , kankakee and will counties ( greater chicago region ) as part of the illinois medicare-medicaid alignment initiative . upon execution of a contract and regulatory approval , enrollment is expected to begin in 2014. in august 2012 , we were notified by the odjfs that buckeye , our ohio subsidiary , was selected to serve medicaid members in a dual-eligible demonstration program in three of ohio 's pre-determined seven regions : northeast ( cleveland ) , northwest ( toledo ) and west central ( dayton ) . story_separator_special_tag the year over year decrease in the g & a expense ratio reflects the leveraging of expenses over higher revenues in 2012 and a reduction in performance based compensation expense in 2012 which lowered the g & a expense ratio by approximately 60 basis points . impairment loss during 2011 , the company completed its annual goodwill and intangible asset impairment testing and concluded that the fair value of all reporting units with material amounts of goodwill was substantially in excess of the carrying value as of our impairment testing date . specifically , the company tested its celtic reporting unit under a quantitative model which included anticipated financial performance for new business to be converted in 2012. under the quantitative model , the testing revealed that the carrying value exceeded fair value of the celtic reporting unit by approximately 190 % . during 2012 , our subsidiary , celtic insurance company , experienced a high level of medical costs for individual health policies , especially for recently issued policies related to members converted from another insurer during the first quarter of 2012. additionally , in june 2012 , the u.s. supreme court upheld the constitutionality of the patient protection and affordable care act . the affordable care act , among other things , limits the profitability of the individual health insurance business because of minimum medical loss ratios , guaranteed issue policies , and increased competition in the marketplace product . as a result of these factors , our expectations for future growth and profitability were lower than previous estimates and we conducted an impairment analysis of the identifiable intangible assets and goodwill of the celtic reporting unit . the impairment analysis resulted in goodwill and intangible asset impairments of $ 28.0 million , recorded as an impairment loss in the consolidated statement of operations . the impaired identifiable intangible assets of $ 2.3 million and goodwill of $ 25.7 million were reported under the specialty services segment ; $ 26.6 million of the impairment loss is not deductible for income tax purposes . 41 investment and other income , net the following table summarizes the components of other income ( expense ) for the year ended december 31 , ( $ in millions ) : replace_table_token_13_th investment income . the increase in investment income in 2012 primarily reflects higher investment balances in 2012. gain on sale of investments . during the year ended december 31 , 2012 , we recognized $ 1.5 million in net gains primarily as a result of the liquidation of $ 75.5 million of investments held by the georgia health plan in order to meet short term liquidity needs due to delays in premium receipts from the state . gain on sale of investment in convertible note . between july 2008 and october 2011 , we made an investment of $ 30.0 million in secured notes receivable to a third party as part of an investment in certain medicaid and medicare related businesses . the notes included a feature to convert the note balance into an equity ownership in the underlying businesses . in september 2012 , we executed an agreement with the borrower whereby the borrower agreed to pay us total consideration of $ 50.0 million for retirement of the outstanding notes and equity ownership conversion feature . as a result , during the third quarter of 2012 , we recorded a pre-tax gain of $ 17.9 million in other income representing the fair value of the total consideration in excess of the carrying value of the loans on the balance sheet . interest expense . interest expense increased during the year ended december 31 , 2012 by $ 0.2 million reflecting the issuance of an additional $ 175 million in senior notes in november 2012 , partially offset by the refinancing of our $ 250 million senior notes and execution of the associated interest rate swap agreement in may 2011. income tax expense excluding the effects of noncontrolling interests , our effective tax rate for 2012 was 34.9 % compared to 37.0 % in 2011 . the tax rate for the year ended december 31 , 2012 , reflects a tax benefit resulting from the clarification by a state taxing authority regarding a state income tax calculation , partially offset by celtic 's non-deductible goodwill impairment . segment results the following table summarizes our operating results by segment for the year ended december 31 , ( in millions ) : replace_table_token_14_th managed care premium and service revenues increased 55.6 % in the year ended december 31 , 2012 , due to the addition of our illinois , louisiana , mississippi , missouri and washington contracts , texas expansion , pharmacy carve-ins in texas and ohio , and organic membership growth . earnings from operations decreased $ 99.0 million in the year ended december 31 , 2012 , 42 primarily due to higher medical costs in our texas health plan specifically in the expansion areas and increased flu costs during the fourth quarter of 2012. specialty services premium and service revenues increased 77.0 % in the year ended december 31 , 2012 , due to ( 1 ) the carve-in of pharmacy services in texas and ohio , ( 2 ) specialty company revenue related to the growth in our medicaid segment and the associated specialty services provided to this increased membership and ( 3 ) the arizona expansion . earnings from operations increased $ 3.2 million in the year ended december 31 , 2012 , reflecting growth in our pharmacy business and the associated specialty services provided to our increased medicaid membership , partially offset by the impairment loss of $ 28.0 million recorded in 2012 and a high level of medical costs in celtic insurance company , especially for members converted in the first quarter of 2012. liquidity and capital resources shown below is a condensed schedule of cash flows for the years ended december 31 , 2013 , 2012 and

