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Former Connecticut business owner pleads guilty to billing insurers for breast prostheses never provided

Jacqueline Pelphrey, who ran a Vernon post-mastectomy supply business, admitted causing more than $1.29 million in losses to Medicaid and other health plans, federal prosecutors said.

A Pennsylvania woman who formerly lived in Manchester, Connecticut, pleaded guilty Tuesday in federal court in Hartford to health care fraud. Federal prosecutors said she billed Medicaid and private insurers for custom breast prostheses that her clients never ordered, bought or received.

Jacqueline Pelphrey, 50, of Freedom, Pennsylvania, waived her right to be indicted and pleaded guilty to a single count of health care fraud, according to the U.S. attorney's office for the District of Connecticut.

Pelphrey owned and ran Women's Health Resources Inc., which did business as Essentials for the Special Woman in Vernon, prosecutors said. The business sold post-mastectomy products, including custom breast prostheses, and billed health care benefit programs for them.

Beginning no later than August 2018, Pelphrey submitted fraudulent claims through the business to Medicaid, private insurers and health plans whose claims private insurers processed, prosecutors said. The claims were for custom breast prostheses her clients did not order, purchase or receive.

As part of her plea, Pelphrey admitted that she caused $1,299,633.10 in losses to Medicaid and other health insurance plans, according to the U.S. attorney's office.

Health care fraud carries a maximum sentence of 10 years in prison. Pelphrey is free on a $10,000 bond. Her sentencing is scheduled for Dec. 29 in federal court in Bridgeport.

The U.S. Department of Health and Human Services' Office of Inspector General and the FBI investigated the case.

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