//
you're reading...
Politics, Congress, Investigation, Republicans, FBI, internet, health, Economy, Education, Wikipedia, local news, Press Release, Justice Department, Democrats, meta, Fraud, National News, Environment

PRESS RELEASE: Four Former WellCare Health Plans Inc. Executives Found Guilty in Florida

Department of Justice
Office of Public Affairs
FOR IMMEDIATE RELEASE
Monday, June 10, 2013

Four Former Wellcare Executives Found Guilty in Florida

A federal jury in Tampa found four former executives of WellCare Health Plans Inc., a health maintenance organization (HMO) operator, guilty of various charges, including health care fraud, making false statements relating to health care matters and making false statements to a law enforcement officer, announced Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division, U.S. Attorney Robert E. O’Neill of the Middle District of Florida and Special Agent in Charge Christopher B. Dennis of the U.S. Department of Health and Human Services Office of Inspector General (HHS-OIG), Office of Investigations Miami office

Today, former WellCare Chief Executive Officer Todd S. Farha, 45, of Tampa, was convicted of two counts of health care fraud; former WellCare Chief Financial Officer Paul L. Behrens, 51, Odessa, Fla., was convicted of two counts of making false statements relating to health care matters and two counts of health care fraud; William L. Kale, 63, of Oldsmar, Fla., former vice president of Harmony Behavioral Health Inc. (a wholly-owned subsidiary of WellCare), was found guilty of two counts of health care fraud; and Peter E. Clay, 56, of Wellesley, Mass., former WellCare vice president of medical economics, was found guilty of making false statements to a law enforcement officer.

On March 2, 2011, a federal grand jury sitting in Tampa returned an indictment charging Farha, Behrens, Kale and Clay with various federal criminal violations related to a scheme to defraud the Florida Medicaid program, from the summer of 2003 through the fall of 2007, by making false and fraudulent statements relating to expenditure information for behavioral health care services.

WellCare operates HMOs in several states targeted for government-sponsored health care benefit programs like Medicaid. Two WellCare HMOs operating in Florida, StayWell and Healthease, contracted with the Agency for Health Care Administration (AHCA), the Florida agency which administers the Medicaid program, to provide Florida Medicaid program recipients with an array of services, including behavioral health services.

In 2002, Florida enacted a statute that required Florida Medicaid HMOs to expend 80 percent of the Medicaid premium paid for certain behavioral health services upon the provision of those services. In the event that the HMO expended less than 80 percent of the premium, the difference was required to be returned to AHCA. As part of the scheme, the defendants falsely and fraudulently submitted inflated expenditure information in the company’s annual reports to AHCA, in order to reduce the WellCare HMOs’ contractual payback obligations for behavioral health care services.

On May 5, 2009, the government filed related charges in an information and deferred prosecution agreement (DPA) against WellCare. Under that DPA, WellCare was required to pay $40 million in restitution, forfeit another $40 million to the United States and cooperate with the government’s criminal investigation. The company complied with all of the requirements of the DPA. As a result, the information was later dismissed by the court following a government motion.

In May 2009, an information and plea agreement for Gregory West, 55, of Tampa, a former WellCare analyst, was unsealed. In his plea agreement, West admitted to participating in the scheme to defraud the Medicaid program and agreed to cooperate in the government’s investigation. At trial, West provided extensive and detailed testimony explaining the complex scheme. Other former WellCare executives provided additional testimony about the four individuals’ roles in the scheme.

The maximum penalty for each of the health care fraud counts is 10 years in prison. The maximum penalty for all other counts is five years in prison. A sentencing date has not yet been set.

Thaddeus M.S. Bereday, of Tampa, WellCare’s former general counsel, was severed from the trial in February of this year. He will be tried separately, at a later date. Defendants are presumed innocent until proven guilty in a court of law.

The jury returned not guilty verdicts with respect to several counts and was unable to reach a verdict on others. The judge declared a mistrial as to those counts on which the jury was deadlocked. The Justice Department will decide, at a later date, whether to retry the individuals on those charges.

This case was investigated by HHS-OIG, the FBI and the Florida Attorney General’s Medicaid Fraud Control Unit. It was prosecuted by Senior Litigation Counsel John Michelich of the Criminal Division’s Fraud Section and Assistant U.S. Attorneys Jay Trezevant and Cherie Krigsman of the Middle District of Florida and Special Assistant U.S. Attorney John Bowers.

About these ads

About FREDERICA CADE

Most of the information you will see comes from some Federal/state Government documents or Federal/State Governm Agency. -----------------------------------------------The fellow that can only see a week ahead is always the popular fellow, for he is looking with the crowd. But the one that can see years ahead, he has a telescope but he can't make anybody believe that he has it. ~~~~Will Rogers __The woman who follows the crowd will usually go no further than the crowd. The woman who walks alone is likely to find herself in places no one has ever been before.~ Albert Einstein ~"I never work better than when I am inspired by anger; for when I am angry, I can write, pray, and preach well, for then my whole temperament is quickened, my understandingsharpen​ed, and all mundane vexations and temptations depart.” ~Dr. Martin Luther King Jr. _________________________________________________________________________________________ ~"The bosom of America is open to receive not only the Opulent and respectable Stranger, but the oppressed and persecuted of all Nations and Religions; whom we shall welcome to a participation of all our rights and privileges, if by decency and propriety of conduct they appear to merit the enjoyment".~___________________________________ George Washington, Address to the Members of the Volunteer Association of Ireland, December 2, 1783 Fredericacade@gmail.com

Discussion

No comments yet.

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

Frederica Cade’s Blog (Politics, News, Analysis, Investigation, Press Releases, Education, Economics, Internet, News Releases, Featured stories, Fraud, and History, U.S. Laws, Posted stories, Index of reports, meta,Home page)

Blog Stats #

  • 509,360 hits

Frederica Cade’s Archives

Twitter Updates

Recent Post

July 2013
M T W T F S S
« Jun   Aug »
1234567
891011121314
15161718192021
22232425262728
293031  

Frederica Cade’s Blog (Politics, News, Analysis, Investigation, Press Releases, Education, Economics, Internet, News Releases, Featured stories, Fraud, and History, U.S. Laws, Posted stories, Index of reports, meta,Home page)

Politics, local News, National News, Foreign news, Congress, President, Government, Economics, Analysis, Art, Health,Investigation, FBI, Justice Department, Fraud, Press Releases, Health Care, News Releases, Law, and History Tags

2012 Elections Affordable Care Act Alabama Albuquerque ALEC Alexandria American Legislative Exchange Council AMERICAN LEGISLATIVE EXCHANGE COUNCIL (ALEC) Analysis Arizona Atlanta Attorney General Eric Holder Bain Capital California charter schools Chicago Colorado Congress Connecticut Democrats Deputy Attorney General James M. Cole District of Columbia Economics Economy Education Environ Environme Environmen Environment EPA FBI Federal Election Commission (FEC) Florida fraud FreedomWorks General Georgia Governor Nikki Haley Grover Norquist Hammond Health Health and Human Services (HHS) Secretary Kathleen Sebelius Health Care Heritage Foundation HHS Secretary Kathleen Sebelius History https://fredericacade.wordpress.com/wp-admin/edit.php?category_name=politics-congress-investigation-republicans-fbi-internet-health-economy-education-wikipedia-local-news-press-release-justice-departm Idaho Illinois Indiana Internet Investigation Iowa IRS jobs Jr. Justice Department Kansas Kara Pally Keystone XL Knoxville Koch Koch Brothers Koch Industries Laws Lobbying local news Louisiana Maryland Massachusetts Matte Kibbe Memphis meta Michigan Minnesota Mississippi Missouri Mitt Romney Montana Nashville National News Nebraska New Jersey New Mexico News New York Nikki Haley North Carolina Ohio Oklahoma Oregon outsourcing Paul Ryan Pennsylvania Philadelphia Politics President President Obama Press Release Public Schools Puerto Rico record Republicans Rhode Island South Carolina South Dakota Tennessee Texas Top Story TransCanada United States Vincent Sheheen Virginia Voting Rights Act Voting Rights Act of 1965 WASHINGTON Washington D.C. West Virginia Wikipedia Wisconsin

Frederica Cade’s Blog (Politics, News, Analysis, Investigation, Press Releases, Education, Economics, Internet, News Releases, Featured stories, Fraud, and History, U.S. Laws, Posted stories, Index of reports, meta,Home page)

Frederica Cade’s Blog (Politics, News, Analysis, Investigation, Press Releases, Education, Economics, Internet, News Releases, Featured stories, Fraud, and History, U.S. Laws, Posted stories, Index of reports, meta,Home page)

Frederica Cade's Blog

Just another WordPress.com weblog

WordPress.com News

The latest news on WordPress.com and the WordPress community.

Follow

Get every new post delivered to your Inbox.

Join 1,706 other followers