Former Connecticut Resident Pleads Guilty to Health Care Fraud
Jacqueline Pelphrey, a 50-year-old former resident of Manchester, Connecticut, pleaded guilty in Hartford federal court to a health care fraud charge carrying a maximum term of imprisonment of 10 years. Pelphrey, currently residing in Freedom, Pennsylvania, waived her right to be indicted and admitted to orchestrating a scheme that submitted fraudulent claims for custom breast prostheses to Medicaid, private insurers, and other health care benefit programs.
Fraudulent Claims Submitted Through Women’s Health Resources
Court documents and statements made in court establish that Pelphrey owned and operated Women’s Health Resources Inc., doing business as Essentials for the Special Woman, located in Vernon, Connecticut. The business sold post-mastectomy items and products directly to clients and filed reimbursement claims with various health care benefit programs. Beginning no later than August 2018, Pelphrey operated a scheme to defraud Medicaid and private insurance plans by billing them for custom breast prostheses that her clients had never ordered, purchased, or received.
As part of her guilty plea, Pelphrey acknowledged responsibility for causing a total of $1,299,633.10 in financial losses to Medicaid and other health insurance programs.
Federal Agencies Investigate Case as Pelphrey Awaits Sentencing
The criminal case was investigated by the U.S. Department of Health and Human Services Office of the Inspector General and the Federal Bureau of Investigation. The guilty plea was jointly announced by David X. Sullivan, United States Attorney for the District of Connecticut; Roberto Coviello, Special Agent in Charge of the U.S. Department of Health and Human Services; and P.J. O’Brien, Special Agent in Charge of the New Haven Division of the FBI.
Assistant U.S. Attorney David J. Sheldon is prosecuting the case. Following her guilty plea, Pelphrey was released on a $10,000 bond pending her sentencing hearing, which is scheduled for December 29 in Bridgeport.
Justice Department Creates National Fraud Enforcement Division
On April 7, the Department of Justice announced the creation of the National Fraud Enforcement Division, known as the Fraud Division, which focuses on investigating and prosecuting individuals who commit fraud against the American people. This enforcement activity contributes to President Trump’s Task Force to Eliminate Fraud, which is a comprehensive interagency initiative targeting waste, fraud, and abuse in federal benefit programs and is led by Vice President J.D. Vance.