Former Connecticut Resident Pleads Guilty to Health Care Fraud Charge

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 Federal Bureau of Investigation, announced that JACQUELINE PELPHREY, 50, of Freedom, Pennsylvania, waived her right to be indicted and pleaded guilty today in Hartford federal court to health care fraud.

According to court documents and statements made in court, Pelphrey, formerly of Manchester, Connecticut, owned and operated Women's Health Resources Inc. d/b/a Essentials for the Special Woman ("Women's Health Resources"), located in Vernon. Women's Health Resources sold post-mastectomy items and products, including custom breast prostheses, to clients and submitted claims to health care benefit programs for the items. Beginning no later than August 2018, Pelphrey engaged in a scheme to defraud health care benefit programs, including Medicaid, private insurers, and health care benefit programs for which private insurers processed claims, by submitting fraudulent claims from Women's Health Resources to the programs for custom breast prostheses that Pelphrey's clients did not order, purchase, or receive.

As part of her plea, Pelphrey admitted that she caused a total of $1,299,633.10 in losses to Medicaid and other health insurance plans.

Health care fraud carries a maximum term of imprisonment of 10 years. Pelphrey is released on a $10,000 bond pending sentencing, which is scheduled for December 29 in Bridgeport.

The investigation has been conducted by the U.S. Department of Health and Human Services, Office of the Inspector General, and the Federal Bureau of Investigation. The case is being prosecuted by Assistant U.S. Attorney David J. Sheldon.

On April 7, the Department of Justice announced the creation of the National Fraud Enforcement Division ("Fraud Division"). The Fraud Division is laser-focused on investigating and prosecuting those who commit fraud against the American people. The Department's work to combat fraud supports President Trump's Task Force to Eliminate Fraud, a whole-of-government effort chaired by Vice President J.D. Vance to eliminate fraud, waste, and abuse within Federal benefit programs.