A woman who once ran a post-mastectomy supply shop out of Vernon has pleaded guilty to federal health care fraud after admitting she billed Medicaid and private insurers almost $1.3 million for custom breast prostheses that her clients never ordered, never bought, and never received.
Jacqueline Pelphrey, 50, now living in Freedom, Pennsylvania, previously lived in Manchester and owned and operated Women's Health Resources Inc., doing business as Essentials for the Special Woman, out of 54 Hartford Turnpike in Vernon, according to the Hartford Courant. Court records cited by the paper describe how the business sold post-mastectomy items and custom breast prostheses and submitted claims for those products to health care benefit programs. Pelphrey waived her right to be indicted by a federal grand jury and instead pleaded guilty directly in Hartford federal court.
According to a press release from the U.S. Attorney's Office for the District of Connecticut, Assistant U.S. Attorney David J. Sheldon is prosecuting the case, which was investigated jointly by Special Agent in Charge Roberto Coviello of the HHS Office of Inspector General and Special Agent in Charge P.J. O'Brien of the FBI's New Haven Division. The scheme ran from August 2018 onward and targeted both Medicaid and private insurers that processed claims for health care benefit programs, per the same account.
A Decades-Old Business Turned Into a Billing Scheme
Essentials for the Special Woman was not a fly-by-night operation. A Better Business Bureau profile shows the business began operating in November 2003 and was incorporated in Connecticut as Women's Health Resources Inc. in December 2006, with Pelphrey serving as corporate president. That means the company had supplied post-mastectomy goods for roughly fifteen years before prosecutors say the fraudulent billing began.
The scheme exploited a federal coverage guarantee built into the Women's Health and Cancer Rights Act of 1998, which requires group health plans and individual insurers that cover mastectomies to also reimburse post-mastectomy custom breast prostheses and related supplies, according to the Centers for Medicare & Medicaid Services. That mandate created a predictable billing pathway, and prosecutors say Pelphrey submitted claims for custom prostheses that her clients did not order, did not purchase, and never received. Altogether, the Hartford Courant reports, Pelphrey caused $1,299,633.10 in losses to Medicaid and other health insurance plans.
Bond and Sentencing
Pelphrey remains free on a $10,000 bond while she awaits sentencing on December 29 in federal court in Bridgeport.
Fraud Recoveries Add Up Statewide and Nationally
The financial stakes of Medicaid fraud enforcement are substantial. The HHS Office of Inspector General's fiscal year 2025 annual report, released in March 2026, found that state Medicaid Fraud Control Units recovered nearly $2 billion nationally, returning $4.64 for every dollar spent on enforcement, while securing 1,185 criminal convictions.
Connecticut has its own track record in this space. Regional reporting compiled by Inside Investigator in late 2025 found the state previously ranked 11th nationally for Medicaid fraud recoveries and civil judgments, generating $27.5 million in state enforcement recoveries.
Pelphrey's sentencing in late December will determine how much of the nearly $1.3 million she will be ordered to repay and what prison term, if any, she will serve under the statutory framework outlined by federal prosecutors.
