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Health News Florida

Former WellCare Execs Blame the State

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The day that WellCare Health Plans dreaded for years arrived on Tuesday: The criminal trial of four company ex-executives began in earnest in Tampa's federal court, with lots of accusations about health fraud and conspiracy.

As the Tampa Tribune reported, interest in the case is so high that the courtroom was packed, with spillover space on another floor.

Defense attorneys for Todd Farha and three other former top WellCare officials said their clients did not break the law. They signaled they will blame others -- including the Florida Agency for Health Care Administration, saying Medicaid officials there misled the executives.

But the federal prosecutor said she will show that Farha and the others "cooked the books," the Tribune reported.

Before either team of lawyers can start trying to prove their case, they have to give the jury training on how the Medicaid managed-care system works -- including the "medical-loss ratio," a requirement that the company spend a certain percentage of the premium dollar on health care. The gist of the case is that the  accused  executives created false financial statements to make it appear that the company was spending the required amount on patients when it really wasn't.

The trial is expected to last for months.

For a good summary of what led to this trial, check out this account from Bloomberg News, published in November.

Jack Maurer, vice president for corporate communications at WellCare, sent a statement to Health News Florida and other media on Tuesday asking that they make clear the criminal charges stem from the years 2003-07.

"The company acted swiftly in October 2007 upon learning of the wrongdoing and separated the individuals involved," he wrote. "We cooperated fully with state and federal authorities in their investigations, and resolved all of the issues that directly involved the company, including obtaining a Corporate Integrity Agreement. In fact, WellCare has its own pending litigation against three of the accused individuals.

"These executives and their actions did not and do not reflect the hard work, dedication and ethics of WellCare’s employees and managers – both then and now," Maurer wrote.

"The trials are completely separate from who WellCare is today, how we run our business and our focus on providing quality care to our members."