In the event that WellCare fails to comply with the provisions of the DPA, then WellCare agrees that the U.S. Attorney may proceed with its prosecution of WellCare and that WellCare will stipulate and agree that the statement of facts attached to the DPA may be used against it in the prosecution.
The Investigation of and Allegations Against WellCare
The government first revealed its ongoing investigation concerning WellCare on Oct. 24, 2007, when more than 200 Special Agents and investigators from the FBI, the Office of the Inspector General of the United States Department of Health and Human Services (HHS-OIG), and the State of Florida Medicaid Fraud Control Unit, Office of The Attorney General (MFCU), raided WellCare offices at 8735 Henderson Road in Tampa, Fla.
The investigation of WellCare focused upon allegations that WellCare, through its executives and employees, falsely and fraudulently inflated expenditure information that it submitted to the Florida Medicaid and Healthy Kids programs from mid-2002 through 2006. The information specifically charges that WellCare submitted fraudulently inflated expenditure information to the Florida Medicaid program (through Florida's Agency for Health Care Administration, or AHCA), on required Behavioral Healthcare Worksheets. The information further charges that WellCare submitted falsely and fraudulently inflated expenditure information to the Healthy Kids program in annual filings that were required under its contracts with the program. The information alleges that one of the primary methods WellCare used to defraud the health care programs was the creation of:
"...A wholly-owned entity named Harmony Behavioral Health, Inc. (formerly known as WellCare Behavioral Health, Inc.), [that WellCare used] to conceal and falsely and fraudulently inflate [its health] plans' true and actual expenses incurred in providin
|SOURCE U.S. Department of Justice|
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