Federal health care fraud charges that have been making headlines for almost six years have reached a resolution against four defendants indicted with various charges. Early last week, a federal jury delivered “mixed verdicts” regarding four former executives of WellCare Health Plans.
WellCare Health Plans, Inc. is a publicly owned health care company that offers Medicaid and Medicare managed health care plans for more than its 2 million participants. The company began operations in 1985 as a Medicaid provider for Florida with its main headquarters located in Tampa. They have affiliations with more than 90,000 doctors and works with over 3,500 associates. The company is also a holding company for numerous affiliates, including Staywell, HealthEase, Harmony, and ‘ Ohana Health Plans. WellCare maintains local offices in Miami, Florida; Chicago, Illinois New York City; Baton Rouge, Louisiana: North Haven, Connecticut; Marietta, Georgia; and Houston, Texas.
In October 2007, more than 200 Special Agents accompanied by the FBI, the Department of Health and Human Services as well as the Florida Attorney General’s Medicaid Fraud Control Unit raided WellCare’s Tampa based headquarters and executed a search warrant of the company’s offices.
It was alleged that the company overstated expenses by handing in bogus documents to the state. Under selected mental health care agreements, WellCare was paid a flat fee for each patient and was expected to disburse at least eighty percent of the received funds on the care of each individual patient. Surplus amounts of more than 20 percent were to be refunded to the state. However, the company’s invented bogus outlays permitted them to keep the remaining monies.
Prosecutors went forward with the charges and with the testimony of a former employee had the allegations corroborated opening up a can of worms that came to at least a semi-conclusion last week.
In a plea agreement that has since been unsealed WellCare agreed in to repay $35 million of the ill-gotten gains, which was the company’s best approximation of the total amount that was deceptively retained by the company between the years of 2002-2006. The company was forced to restate its quarterly and annual profits after the raid occurred.
This action drove net income down by $32 million, and triggered resignation of the company’s top three officials. There were no criminal charges filed at the time but investigations were announced by both the States of Florida and Connecticut. The SEC also began an informal investigation. Several shareholder lawsuits and sealed whistleblower complaints were also filed. WellCare’s publicly traded stock (NTSE: WCG) was halted on the news. Once it reopened for trading it quickly fell to a low of eighty percent below that year’s (2007) annual high price per share.
In May of 2009 charges were filed and a Deferred Prosecution Agreement (DPA) was initiated in part of which the company agreed to pay $40 Million in restitution to the Florida Medicaid and Healthy Kids programs in repayment of proceeds from those platforms that WellCare was not entitled to, and additionally consented to another civil forfeiture of $40 Million. The company also had to accept all responsibility for the behavior that led to the investigation by the government as well as accepting its knowledge of the unlawful events that took place.
Among other terms of the DPA, the company was required to continue its cooperation in the ongoing federal and state criminal investigation of its former executives.
In March 2011 U.S. Attorney Robert E. O’Neill announced the return by a grand jury of an indictment charging five former officials of WellCare with conspiracy to commit Medicaid fraud, false statements, and further associated charges. Explicitly, the indictment charges that Todd S. Farha, 42, the former chief executive officer; Thaddeus M.S. Bereday, 45 former general counsel; Paul L. Behrens, 49 former chief financial officer; William L. Kale, 61, a former vice president of Harmony Behavioral Health, Inc., a exclusively-owned subsidiary of WellCare; and Peter E. Clay, 54, former vice president of Medical Economics were the focus of the indictment.
In 2012, WellCare paid $137.5 million to the nine states and the federal government to decide four lawsuits that had alleged abuses of the False Claims Act.
On June 10, 2013 after weeks of deliberation a jury of 10-women and two men provided an assortment of verdicts finding four of the executives guilty of at least some of the criminal charges against them but acquitting them of other allegations.
Farha, Behrens, and Kale were each found guilty of two counts of health care fraud but Farha was acquitted of six other charges including giving false statements. Behrens was found guilty of two counts of making false statements, but was acquitted of two other false statement charges. Clay was the lone defendant not convicted of health care fraud but was found guilty of two counts of making false statements.
Federal charges are still pending against former WellCare general counsel Thaddeus M.S. Bereday
The four men swindled the government out of more than $30 million. The money they appropriated to their company should have been used for people who were in need of their health care services, not to increase the earnings of a company that was already profitable, prosecutors said.
Each health care fraud count is punishable by up to 10 years’ imprisonment. The maximum penalty of incarceration for each of the other convictions has a maximum of five years.
To read the latest FBI press release relating to this article click here