A former financial planner at the Tampa company WellCare pleaded guilty to conspiring to defraud the Medicaid program. He is now testifying in the criminal trials against four executives of WellCare in connection with the same Medicaid fraud activities. The company is accused of sending false information regarding how much state money WellCare spent of providing mental health services for its patients.
The company accepted money from the State of Florida through the Medicaid program on the condition that it must spend 80 percent of it for behavioral health services. If it failed to do so, the difference was required to be returned. Allegedly, in order to keep a larger percentage of that money, the company falsified information regarding time spent on mental health services for patients insured through WellCare HMOs.
The former chief executive officer, general counsel, chief financial officer and two vice presidents of WellCare were indicted in 2011 for conspiracy to commit Medicaid fraud and making false statements. According to prosecutors, the company kept $30 million more than they would have without the falsified information. Attorneys for the defendants stated that the state was aware of the company's actions but failed to provide any guidance to indicate that it violated the arrangement.
Medicaid and Medicare billing arrangements are often complex. Prosecutors have targeted individuals and businesses working with these programs in numerous fraud cases. The penalties for health care fraud are severe and many result in lengthy prison sentences and massive fines.
Source: Tampa Bay Times, "Former WellCare employee testifies on role in Medicaid fraud," by Jodie Tillman, 7 March 2013