WellCare Health employee guilty of $20M Medicaid fraud

The U.S. Department of Justice has revealed that a former employee of WellCare Health Plans has pleaded guilty to charges that he conspired to fraud the Florida Medicaid program out of more than $20 million. The employee, Gregory West of Tampa, FL, could be sentenced to as many as 10 years in prison a fine of up to $250,000.

West, along with unnamed co-conspirators, admitted to having taken part in a scheme to defraud Florida's Medicaid agency, the Agency for Health Care Administration. West and his partners inflated expenses submitted to the AHCA from 2002 to 2006 as a means of cutting down the amount WellCare had to pay back the state. As the contract was written, WellCare was only allowed to keep 20 percent of premiums to pay administrative expenses, so if it cost the company less than 80 percent to provide member services, it was supposed to pay that excess back to the state.

West's guilty plea came two months after state and federal officials raided WellCare's Tampa headquarters. WellCare, which offers managed care services for government health programs, later underwent a series of dramatic changes, including seeing its stock fall precipitously, its entire executive team replaced, financial information restated back to 2004 and a $32.5 million refund to the state of Florida under its Medicaid contract.

To learn more about West's plea:
- read this Tampa Bay Business Journal article

Related Articles:
WellCare to pay $32.5M settlement
WellCare budgets $35M for employee retention

Suggested Articles

The profit margins and management of Community Health Group raise questions about oversight of managed care insurers.

Financial experts are warning practices about the pitfalls of promoting medical credit cards to their patients.

A proposed rule issued by HHS on Tuesday would expand short-term coverage, a move Seema Verma said will have "virtually no impact" on ACA premiums.