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WellCare worker's plea deal points to Medicaid fraud

By Kevin Graham, Times Staff Writer
In print: Wednesday, October 8, 2008

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TAMPA — Recently unsealed federal court documents reveal details of what prosecutors call an "elaborate scheme" by WellCare Health Plans Inc. employees to defraud Florida's Medicaid program of more than $20-million.

A plea agreement showed that former WellCare employee Gregory West, 50, of Tampa and other WellCare employees fraudulently inflated bills for health care services submitted to the state Agency for Health Care Administration from mid 2002 through 2006.

West pleaded guilty in December to conspiracy to defraud the Florida Medicaid program, court records show. He faces a maximum of 10 years in prison and up to a $250,000 fine, according to the U.S. Attorney's Office.

Prosecutors said West directed others, who aren't named in the plea agreement, to falsify records to hide the fraud.

In October 2007, FBI agents and other federal and state agencies raided the Tampa headquarters of WellCare as part of a Medicaid fraud investigation. The company has said it will pay $35.2-million as part of an agreement with prosecutors. But the payment doesn't settle the case or limit the U.S. government and state of Florida from making further claims in their investigation.