Marc H. Silverman, Acting U.S. Attorney for the District of Connecticut, announced that Thelma “Wendy” Epps, 60, of Hartford, was sentenced on January 31, 2025, to 27 months in prison, followed by three years of supervised release, for health care fraud.
U.S. District Judge Kari A. Dooley in Bridgeport ordered Epps to pay $1,001,058.43 in restitution to the Connecticut Medicaid program.
Epps, a Licensed Alcohol and Drug Abuse Counselor (LADC), operated from an office at 330 Main Street in Hartford. In April 2013, she enrolled as a Medicaid provider along with her entity, Miracles to Destiny LLC. However, in July 2018, Medicaid suspended her after a credible fraud allegation. She was warned that submitting claims through other providers or billing numbers would result in termination from the program (see US Health Insurance Market Trends).
In 2019, Epps partnered with Dennis Tomczak, a Connecticut LADC, to bill Medicaid for psychotherapy services she claimed to provide. Tomczak submitted these claims under his provider number, falsely stating he performed the services. In exchange, Epps paid him 25% of Medicaid’s reimbursement. Between April 2019 and November 2022, Medicaid paid Tomczak $330,547.71 for fraudulent claims linked to Epps.
As the scheme progressed, Tomczak questioned the number of services Epps claimed. She then arranged a similar agreement with Shawn Tyson, another Connecticut LADC.
Epps helped Tyson enroll as a Medicaid provider and used his login credentials to submit claims. Before Tyson’s enrollment, Epps billed Medicaid for services allegedly provided by Tyson under Tomczak’s provider number without Tomczak’s knowledge. Medicaid paid Tomczak $7,879.40 for these claims.
Under their arrangement, Tyson gave Epps patient names and dates for supposed psychotherapy services, and she billed Medicaid under his provider number. She also submitted false claims stating Tyson provided services he did not. If services were billed on holidays like July 4 or Thanksgiving, Tyson adjusted the dates before resubmitting. Medicaid paid Tyson $663,081.32 for fraudulent claims.
Epps pleaded guilty to health care fraud on November 8, 2024. She is out on a $50,000 bond and must report to prison on March 3.
Tomczak and Tyson also pleaded guilty and await sentencing.
The U.S. Department of Health and Human Services, Office of the Inspector General, the FBI, and the Connecticut Department of Social Services investigated the case. Assistant U.S. Attorney David J. Sheldon and Auditor Susan Spiegel prosecuted.
The Medicaid Fraud Working Group, which includes federal and state agencies, regularly reviews fraud cases and trends to improve enforcement efforts.
Section 1331 of the Affordable Care Act gives states the option of creating a Basic Health Program (BHP), a health benefits coverage program for low-income residents who would otherwise be eligible to purchase coverage through the Health Insurance Marketplace. The Basic Health Program gives states the ability to provide more affordable coverage for these low-income residents and improve continuity of care for people whose income fluctuates above and below Medicaid and Children’s Health Insurance Program (CHIP) levels.
Through the Basic Health Program, states can provide coverage to individuals who are citizens or lawfully present non-citizens, who do not qualify for Medicaid, CHIP, or other minimum essential coverage and have income between 133 percent and 200 percent of the federal poverty level (FPL). People who are lawfully present non-citizens who have income that does not exceed 133 percent of FPL but who are unable to qualify for Medicaid due to such non-citizen status, are also eligible to enroll.
Consistent with the statute, benefits will include at least the ten essential health benefits specified in the Affordable Care Act. The monthly premium and cost sharing charged to eligible individuals will not exceed what an eligible individual would have paid if he or she were to receive coverage from a qualified health plan (QHP) through the Marketplace. A state that operates a Basic Health Program will receive federal funding equal to 95 percent of the amount of the premium tax credits and the cost sharing reductions that would have otherwise been provided to (or on behalf of) eligible individuals if these individuals enrolled in QHPs through the Marketplace.