For immediate release
October 6, 2008
http://www.usdoj.gov/usao/flm/prr                                                  

MAN ACKNOWLEDGES ROLE IN CONSPIRACY TO DEFRAUD FLORIDA MEDICAID PROGRAM

Tampa, Florida - United States Attorney Robert E. O'Neill today announced the unsealing of an information and plea agreement for Gregory West–formerly an employee of a WellCare Health Plans, Inc., subsidiary. WEST, a 50-year-old resident of Tampa, Florida, pleaded guilty in December 2007, to conspiracy to defraud the Florida Medicaid program out of more than $20 million. The maximum penalty WEST faces is ten years' imprisonment and a $250,000.00 fine.

According to WEST’s plea agreement, WEST and others participated in an elaborate scheme to defraud the Agency for Health Care Administration (“AHCA”), the agency charged with administering the Florida Medicaid program. Per the plea agreement, in order to fraudulently reduce contractual payback obligations to AHCA, WEST and others falsely and fraudulently inflated expenditure information submitted to AHCA for calendar years mid-2002 through 2006. The fraudulently inflated expenditure information was submitted to AHCA on Behavioral Healthcare Worksheets used to provide a breakdown of expenditures related to the provision of community behavioral health services, as required under Florida Statute 409.912. In addition, per the plea agreement, WEST engaged in a number of conversations and acts in furtherance of the conspiracy including, but not limited to, creating, at the direction of others, a set of false and fraudulent behavioral health encounter data to conceal prior fraudulent submissions in the Behavioral Healthcare Worksheets. As a result of the conspiracy involving WEST and others, AHCA was defrauded of in excess of $20 million.

The case is the latest development in an ongoing investigation being conducted by the Federal Bureau of Investigation, the U.S. Department of Heath and Human Services/Office of Inspector General, and the Florida Attorney General's Medicaid Fraud Control Unit. The investigation is being handled by Assistant United States Attorneys Jay G. Trezevant and Anthony E. Porcelli.