Crime & Courts

Two will plead guilty in $12 million SC autism scam to defraud Medicaid, TriCare

John Monk

Two former employees of a large S.C. autism program have agreed to plead guilty to federal criminal charges stemming from a long-running $12 million scheme to cheat two government-backed insurers.

Ann Davis Eldridge, 57, and Angela Keith, 53, who worked at the S.C. Early Autism Project, have signed agreements to plead guilty to making false statements to Medicaid, a joint federal-state insurance program for low-income and disabled Americans. Both live in Sumter.

No court date has been set.

The government is seeking $3.4 million in restitution from Eldridge and an undetermined amount from Keith, according to plea agreements filed in U.S. District Court in Columbia. Both Eldridge and Keith have agreed to testify in any upcoming grand jury proceedings or trials.

At the Early Autism Project, Eldridge was a senior clinical adviser. Keith was senior vice president of data reporting.

Attorney Joe Griffith Jr. of Charleston, who represents Eldridge, said in an email that “my client is pleading guilty to a misdemeanor and is cooperating with authorities.”

Keith “plans to accept responsibility for a misdemeanor offense,” her attorney, John Simmons of Columbia, said Wednesday.

The plea agreements are part of a federal investigation.

Last week, a federal grand jury in Columbia indicted Susan A. Butler, 55, founder and former top executive of the Early Autism Project.

The grand jury charged Butler with a money-making scheme to over-bill Medicaid and Tricare by inflating bills sent the insurers for treating autistic children. Tricare is a government insurer for active-duty military members and their families.

Federal authorities are seeking to recover $9 million from Butler.

Butler is scheduled to be arraigned Thursday in Columbia. Her lawyer, Beattie Ashmore of Greenville, said Wednesday that Butler, whose son was born with autism, “has devoted her life to helping provide the highest quality of care to children with autism and their families. She is pleading not guilty.”

The Early Autism Project is one of the largest providers of health care services to autistic children in South Carolina.

The federal grand jury indictment charges that money that Medicaid and Tricare paid the Early Autism Project for patient care instead went for administrative costs. Butler also “paid or caused to be paid kickbacks and bribes to clients by illegally offering free child care services for siblings,” and billed Medicaid and Tricare “at higher rates than allowable for the services rendered,” according to the indictment.

The Early Autism Project treats hundreds, offering “the highest quality of intensive, research-based behavioral treatment for children and young adults between 20 months and 21 years with autism spectrum and related disorders,” according to its internet site.

That site says government health insurers — Medicaid and Tricare — will “pay for some or all” autism treatments.

ChanceLight, an autism-care firm with nearly 19,000 clients at more than 150 locations in 20-plus states., bought the Early Autism Project’s S.C. clinics in 2013.

In a statement, ChanceLight said the billing practices questioned by the government were in place when it acquired the Early Autism Project. However, ChanceLight added, “We have completely reformed every policy and procedure to make sure this will not happen again.”

Last August, the U.S. Attorney’s office in Columbia announced the Early Autism Project had paid $8.8 million to settle a civil case under the False Claims Act.

That settlement resolved allegations the Early Autism Project had submitted numerous false bills to Medicaid and Tricare, padding the hours that therapists were performing treatments. The Early Autism Project and its parent company admitted no fault in the settlement.

Records in that case are sealed and not available to the public.

However, the U.S. attorney’s office in Columbia said the case began when a whistleblower, former Early Autism Project employee Olivia Zeigler, brought the allegations to the government’s attention.

Under the False Claims Act, a whistleblower can file a lawsuit on behalf of the government. If the government gets involved, the whistleblower gets part of any money recovered. Zeigler was paid $435,000, the U.S. attorney’s office said.

In Eldridge’s plea agreement, she agreed to sell properties she owns in Columbia, Greenville, Mount Pleasant and Sumter, and turn the proceeds from those sales over to the federal government.

The case is being handled by Assistant U.S. Attorney DeWayne Pearson.

John Monk has covered courts, crime, politics, public corruption, the environment and other issues in the Carolinas for more than 40 years. A U.S. Army veteran who covered the 1989 American invasion of Panama, Monk is a former Washington correspondent for The Charlotte Observer. He has covered numerous death penalty trials, including that of the Charleston church killer, Dylann Roof.