Former Wellcare CEO Sentenced to 36 Months for Florida Medicaid Fraud By Tod Aronovitz | 05/28/14 | 0 Comment

After being convicted of two counts of health care fraud in June 2013, former WellCare Chief Executive Officer Todd S. Farha was sentenced to serve 36 months in prison for Florida Medicaid fraud, the U.S. Department of Justice announced.

The 45-year old from Tampa was involved in orchestrating a scheme to produce inflated expenditure information for the Agency for Health Care Administration (AHCA)—the Florida agency that administers Medicaid—in addition to the company’s annual reports from 2003 through 2007.

This misleading information reduced the amount of money that Wellcare had to reimburse to AHCA as part of its HMO contractual obligations for behavioral health care services for government-sponsored programs, including Medicaid.

Florida law requires that Florida Medicaid HMOs use up 80 percent of the Medicaid premium paid for certain behavioral health services upon the provision of those services. If the HMO spends less than 80 percent, the difference needs to be returned to AHCA.

WellCare, which operates two HMOs in Florida—StayWell and Healthease—had contracted with AHCA to provide Florida Medicaid recipients a variety of services, including behavioral health services. In effect, by falsifying this information, Wellcare was attempting to avoid repaying AHCA, and in the process, defrauded the Florida Medicaid program.

In May 2009, the government filed related charges in an information-and-deferred prosecution agreement (DPA) against WellCare, in which the company had to pay $40 million in restitution, forfeit another $40 million to the United States and cooperate with the government’s criminal investigation. Wellcare complied with the DPA, and as a result, the information was later dismissed by the court following a government motion.

In another related civil qui tam case in 2012, Wellcare agreed to pay $137.5 million in civil fines and penalties.

How to Report Miami Medicare Fraud

Healthcare professionals or medical billing employees who have knowledge of Florida Medicaid fraud or questionable Medicare billing practices can file a confidential legal claim under the False Claims Act. By acting as a “whistleblower” in what is known as a “qui tam” lawsuit, a private party may collect between 10 to 30 percent of the amount recovered, depending on how the case is prosecuted.

ARONOVITZ LAW: Miami Whistleblower / Qui Tam Law Firm

The Miami Qui Tam law firm of ARONOVITZ LAW routinely works with whistleblowers to document Medicare fraud and other forms of fraud against the government. Contact Miami Whistleblower / Qui Tam lawyer Tod Aronovitz to discuss your case.