Plea agreement details WellCare's Medicaid fraud scheme

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

A plea agreement shows that former WellCare employee Gregory West, 50, of Tampa, and other WellCare employees fraudulently inflated expenditure information submitted to the Agency for Health Care Administration from mid-2002 through 2006. Prosecutors said their goal was to fraudulently reduce contractual payment obligations.

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 that West directed others to create false behavioral health encounter data to conceal fake submissions.

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 continuing investigation.

-Kevin Graham, Times staff writer