Wellcare is known as one of the huge insurance health plans in the United States however this insurance was known for violating multiple rules, having allegations, and doing fraud. A fifth former executive at WellCare Health Plans has been sentenced for his role in a $35 million Medicaid fraud scheme. A former general counsel was part of a scheme among top executives at WellCare in 2006 to increase investments for behavioral health in the company’s yearly reports to lessen payback obligations.
The former executives received a six-month prison sentence year 2017 after pleading guilty in June to one count of making a false statement in connection with healthcare matters, the U.S. Department of Justice said in a media release. A federal judge in Tampa ordered Bereday for three years of supervised release that includes one year of home confinement and a fine of $50,000.
The former executive named Thaddeus M.S. Bereday, 52, of Tampa, FL. He was a general counsel in 2016 at WellCare’s Medicaid HMOs StayWell and Healthease. The former executive admitted that he and four other executives submitted inflated expenditures in the company’s annual reports to the Florida Medicaid Program that reduced the HMOs’ payback obligations for behavioral healthcare services statement by the plea agreement.
In 2002, Florida established a statute that required Florida Medicaid HMOs to expend 80 percent of the Medicaid premium they got for certain behavioral health services on the actual requirement of these services to beneficiaries. If the HMO spent less than 80 percent of the premium, the law compelled the excess funds to be returned to the Medicaid Program.
Bereday the former executives and four other defendants were charged in an indictment that alleged how the defendants wrongly and fraudulently schemed to submit inflated payment information in the company’s annual reports to AHCA to reduce the WellCare HMOs’ contractual payback responsibilities for behavioral health care services.
The jury found the executives guilty for their roles in the scheme in 2013 and in 2016 the sentences were all upheld by a federal appellate court.
- WellCare’s former vice president of medical economics Peter E. Clay of Wellesley, Mass., was found guilty of making false statements to a law enforcement officer and sentenced to five years’ probation.
- Todd S. Farha, the former WellCare CEO, was convicted of two counts of healthcare fraud and sentenced to three years in prison.
- William L. Kale sentenced to one year and one day in prison, a former vice president of Harmony Behavioral Health Inc. a subsidiary of WellCare, was found guilty of two counts of healthcare fraud.
- Paul L. Behrens, former WellCare CFO, who was convicted of two counts of making false statements relating to healthcare matters and two counts of healthcare fraud, and received a two-year prison sentence;
The year 2009, WellCare was suited to pay $40 million in restitution, sacrifice another $40 million, and support with the government’s criminal investigation. The company complied with all of the requirements and the criminal information was later dismissed.
On its inception in March 2007, the Medicare Fraud Strike Force, now running in nine cities across the country, has charged nearly 3,500 defendants who have collectively billed the Medicare program for more than $12.5 billion. In addition, the HHS Centers for Medicare & Medicaid Services, operating in connection with HHS-OIG, are considering steps to improve responsibility and lower the appearance of false providers. The Fraud Section directs the Medicare Fraud Strike Force.
