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Health News Florida

Appeals Court Upholds Convictions Of Ex-WellCare Executives

Former CEO Todd Farha in better days.
Former CEO Todd Farha in better days.

In a 124-page ruling, a federal appeals court Thursday upheld the convictions of four formerWellCareHealth Plans executives in a case that stemmed from allegations of defrauding Florida's Medicaid program.

A three-judge panel of the11thU.S. Circuit Court of Appeals upheld convictions against formerWellCareCEO and President ToddFarha; former Chief Financial Officer Paul Behrens; former Vice President of Clinical Services William Kale; and former Vice President of Medical Economics Peter Clay.

The four were indicted by a federal grand jury in 2011 on charges related to alleged fraud that happened years earlier.

Thursday's ruling saidFarha, Behrens and Kale were convicted on charges involving Medicaid fraud in 2006; Behrens was convicted of making false statements on Medicaid reports for 2006; and Clay was convicted on charges of making false statements to federal agents in 2007.

"At trial, the government proved that together the defendants participated in a fraudulent scheme to file false Medicaid expense reports that misrepresented and overstated the amounts (WellCaresubsidiaries)StaywellandHealthEasespent on medical services for Medicaid patients, specifically outpatient behavioral health care services," said the appeals-court ruling written by Judge Frank Hull and joined by judges GeraldTjoflatand J.RandalHall. "By overstating these expenses, the defendants helpedStaywellandHealthEaseretain millions of dollars in tax-subsidized Medicaid funds that they should have refunded to the Florida Agency for Health Care Administration. This, in turn, inflated the profits ofStaywell,HealthEase, andWellCareand earned the defendants financial rewards."

The former executives of the Tampa-based managed care company raised a number of issues in the appeal, including arguments about insufficient evidence and improper jury instructions.

But after hearing oral arguments in October, the appeals court rejected the arguments in an extraordinarily detailed ruling.

Copyright 2016 Health News Florida

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