An embezzlement case related to Sumter-based Early Autism Project Inc. over-billing insurance companies continues as two former employees pleaded guilty earlier this month to making false claims for services that were partly or never rendered.
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In plea agreements dated Jan. 11 and Jan. 16 for former director of clinical services Angela Keith and co-founder Ann Eldridge, respectively, the two defendants agreed to waive indictment and arraignment and pleaded guilty to making false statements in relation to Medicaid benefits between January 2009 and June 2016.
The penalty for the offense is a $1,000 fine and imprisonment for up to one year with one year of supervised release plus a special assessment of $25 for each misdemeanor charge conviction.
Any monetary penalties imposed by the court will have to be paid immediately, according to the plea agreement.
In exchange for the concessions made through the agreements, Keith and Eldridge waive the right to contest any conviction or sentence in a direct appeal or other post-conviction action.
The agreement also requires that Keith and Eldridge testify in front of a grand jury or during any trial when necessary.
Related to the alleged fraudulent billing, Susan Butler, co-founder of EAP, also faces legal action after she was indicted on Jan. 15 for allegedly working with others to defraud Medicaid and Tricare by over-billing for autism-related and other services between January 2007 and June 2016.
If she is convicted, Butler would have to repay the federal government $9,020,589.56.
"Since her son, Collin, was born with autism, Susan Butler has dedicated her life to helping provide the highest quality of care to children with autism and their families," said Beattie Ashmore, Butler's attorney.
"She is pleading not guilty to all charges," he said about Butler's scheduled arraignment in Columbia today.
In a settlement reached on Aug. 2, 2018, EAP agreed to pay $8,833,615 to resolve a False Claims Act investigation regarding the submission of false claims to Tricare and South Carolina Medicaid programs, according to a release from the United States Attorney's Office for the District of South Carolina.
The organization was accused of padding billable time for therapists who had not actively worked with children during those listed hours.
The investigation started when a former employee, Olivia Zeigler, filed a lawsuit under the whistleblower provisions of the False Claims Act in July 2015. Under the act, Zeigler received $435,000 after the U.S. recovered money from the settlement.
As part of the settlement, EAP and its parent company, ChanceLight Inc., entered into a Corporate Integrity Agreement with the Department of Health and Human Services Office of Inspector General to ensure future corporate compliance by requiring internal compliance reforms including hiring an independent review organization to conduct annual claims reviews.
In response to Keith and Eldridge's guilty pleas, ChanceLight - which bought EAP in 2013 - said EAP's billing practices were under investigation before the change in ownership.
"Since then, we have completely reformed every policy and procedure to make sure this will not happen under ChanceLight's ownership," said Sarah Vega, EAP senior vice president for operations.
Immediately after learning of alleged problems, she said, ChanceLight hired outside experts who helped evaluate and enhance billing practices.
"We established a central billing office staffed by medical billers, we established a compliance department to ensure compliance with all regulations regarding billing, and we established a compliance hotline and website staffed by an independent third party to receive parent or employee concerns about billing practices," Vega said.
"Additionally," Vega said, "we have created a data integrity unit to provide additional checks and balances, and an information technology unit to provide technology support."
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