Billing expert pleads guilty in fraud scheme

TAMPA, Fla. – Kelly Wolfe, president of Regency Inc., a medical billing company, has agreed to plead guilty to criminal health care and tax fraud, and to pay $20.3 million in a civil False Claims Act settlement. 

Wolfe, of Indian Rocks Beach, Fla., faces a maximum penalty of 13 years in federal prison. 

Wolfe and her conspirators used Regency to establish dozens of DME shell companies, placing the shell companies in the names of straw owners, according to the Department of Justice. By concealing the true ownership, Wolfe’s conspirators secretly gained control of multiple companies and collectively submitted more than $400 million in fraudulent DME claims for braces to Medicare and the Civilian Health and Medical Program of the VA, the DOJ says.  

“This pernicious telefraud scheme’s ambitions were cut short by the exceptional partnership of our law enforcement partners,” said Special Agent in Charge Omar Pérez Aybar of the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG). “This guilty plea and the forfeiture of tens of millions of dollars back to the U.S. Treasury show our determination to stop such damaging fraud schemes and to bring fraudsters to justice.” 

Wolfe also admitted that for the 2017 tax year she purchased numerous personal items and services using Regency’s funds, but rather than properly report this as income to the IRS, she falsely classified her personal spending as business expenditures. 

The civil settlement resolves claims brought under the whistleblower provisions of the False Claims Act against Wolfe and Regency by Condra Albright, a former Regency employee.  

In 2019, federal agencies launched a nationwide takedown, “Operation Brace Yourself,” on a $1.2 billion fraud scheme involving medically unnecessary braces.