A federal appeals court on Friday upheld the convictions of four former WellCare executives for defrauding Florida's Medicaid program.
In a unanimous 124-page decision, the Eleventh Circuit panel rejected the former executives' claims that their convictions were based on insufficient evidence, errors and improper jury instructions.
Federal prosecutors alleged that former WellCare CEO Todd Farha, Chief Financial Officer Paul Behrens and three others orchestrated a scheme to defraud Florida's Medicaid program of millions of dollars. Under Florida law, 80% of capitated payments to insurers for behavioral health must go to acute care. But the executives doctored financial records to make it appear they were complying with the law, officials said.
Farha, Behrens and former vice president of subsidiary Harmony Behavioral Health William Kale were each found guilty of two counts of health care fraud. Behrens and former WellCare vice president of medical economics Peter Clay were found guilty of two counts of making false statements as well.
Farha has been sentenced to three years in prison and Behrens has received a two-year sentence. Kale will serve one year in prison, and Clay will be on probation for five years.
According to the three-judge panel, the evidence against the four executives was “overwhelming.”
“From beginning to end, the government alleged the defendants' knowledge and intent, not mere recklessness,” the decision said. “For the jury to convict the defendants without finding that they knew the expense reports were false would be to ignore both the district court's jury instructions and the government's whole theory of the case.”
