What is autism?
Two S.C. women were ordered to federal prison Tuesday for their roles in a federal health care fraud in a long-running illegal scheme where a company falsely billed government health insurance programs for some $13 million for supposed care for autistic children.
Magistrate Judge Paige Gossett gave Angela Keith, 53, one year in prison, and Ann David Eldridge, 58, six months in prison. Both live in Sumter.
Had they not pleaded guilty Tuesday to misdemeanor charges of making false statements to federal health programs Medicaid and Tricare, the government could have tried them on felony fraud charges. If they had been convicted, each stood to received a minimum sentence of about four years in prison.
Victims in the case included taxpayers, people who are forced to pay higher health care premiums because of fraud, and autistic children who lost out on getting treatment when the perpetrators submitted bills for care they didn’t get, assistant U.S. Attorney DeWayne Pearson told the judge.
Their former company, the S.C. Early Autism Project, is one of the largest childhood autism providers in South Carolina. The defendants made illegal profits out of filing false claims for non-existent treatment of autistic children covered by Medicaid and Tricare, according to evidence in the case.
At the time of the illegal scheme, from about 2009 to 2016, the “culture and the climate of the Early Autism Project was such that everyone (who worked there) knew the billing practices were fraudulent,” Pearson told the judge. As part of the fraud, employees forged parents’ signatures saying they had received the therapy that the company was billing the government for, he said.
Several whistle blowers brought the fraud to the government’s attention in 2016. One whistleblower was a parent who became concerned that — upon examining the bills — her child was being billed for hours of therapy that the child did not receive, Pearson told the judge Tuesday.
Medicaid is a joint federal-state health insurance program for low-income and disabled families. Tricare is the government insurer for active duty military and their families.
As part of the deal, Keith and Eldridge have agreed to testify against Susan Butler, the major government target in the case and founder and former top-ranking executive in the S.C. Early Autism Project.
Butler’s attorneys, Beattie Ashmore and Deborah Barbier, were in the courtroom Tuesday observing the proceedings but had no comment. A trial date in her case is set for January. The government is seeking to recover some $9 million from Butler.
Parents: Defendants helped autistic children
Tuesday’s relatively light sentences were given because both Keith and Eldridge have agreed to testify against Butler and because both women were active in their community and churches in numerous constructive ways, according to evidence in the case.
Eldridge, represented by attorney Joe Griffith, has already forfeited some $2 million by selling property and — although she made more money from the scheme than Keith — was considered to have played a lesser role in the fraud, Pearson said.
Keith, who was represented by attorney John Simmons, had a financial incentive to overbill the government because she “was able to make hundreds of thousands of dollars in bonuses from the company,” Pearson told the judge.
Judge Gossett also said she was moved by testimony by two mothers of autistic children, who told the judge that Eldridge had spent hundreds of hours working with their children, who had been deemed hopeless cases by doctors, and worked wonders with the children.
After Eldridge leaves prison, part of her sentence will be to continue working with those children, Gossett said.
In August, 2018, Early Autism Project paid the federal government $8.8 million to resolve civil fraud allegations in the case. The fraud lasted from about 2009 until 2016.
In 2013, Early Autism Project was acquired by ChanceLight, a national health care provider that operates in more than 20 states. ChanceLight agreed to participate in a compliance program as part of the $8.8 million settlement. No ChanceLight offiicials face criminal charges in South Carolina.
During the hearing, both women apologized for their actions. Pleading guilty to a misdemeanor allows them get their health care licenses back more easily than if they had been convicted of a more serious felony charge.
Late Tuesday ChanceLight released a statement saying the Early Autism Project’s billing practices were in place before ChanceLight acquired the company in 2013: “Immediately after learning of the investigation, we hired outside experts who helped evaluate and enhance billing practices,” a spokesman said. Numerous other checks have been established, the spokesman added.