SIOUX FALLS — A Mount Vernon woman was sentenced Monday morning to two and a half years in federal prison for embezzling nearly half a million dollars from a long-term health care facility in Mitchell.

Nancy Tingle, 54, the former business manager of Firesteel Healthcare Community (now called Firesteel Healthcare Center), pleaded guilty to health care fraud in December and was ordered Monday to pay $462,811.55 in restitution for the money she embezzled over a six-year period.

Tingle, who between 2012 and fall 2018 understated accounts receivable balances while billing Medicaid for amounts due on Firesteel's books, said the embezzlement began as a way to repay debts but became an addiction.

"It started out small, and then it just grew," she said prior to sentencing. "... I wanted to stop, I just couldn't."

Both U.S. District Judge Karen E. Schreier and Assistant U.S. Attorney Jeremy Jehangiri referenced the closure of Welcov Healthcare due to financial trouble and said some of that trouble was caused by Tingle. Welcov fired Tingle in 2018 after finding account discrepancies, and Washington-based EmpRes Healthcare Management took over Firesteel in early 2019.

According to a factual basis statement filed in November, Tingle embezzled the money by not updating some patients' care levels while billing Medicaid a higher amount for the correct care levels. Tingle would then transfer the difference between the amount paid by Medicaid and the amount on the books to private-pay resident accounts, diverting it for personal use.

Tingle also used Firesteel's only debit card to withdraw cash from the healthcare provider's bank account, which she also used for personal expenses. Additionally, she had a resident draft checks on multiple occasions, telling them those checks would be used to pay for a month's living expenses. She would take that money but also move money around to make Firesteel's accounting records look better than they were.

In July, Tingle was offered a plea agreement that would have required her to plead guilty to both healthcare fraud and tax evasion, with the latter charge accusing her of owing more than $54,000 in federal income taxes in 2017.

Jehangiri, who prosecuted the case, recommended an approximately 24-month sentence for health care fraud, stating Tingle "threw herself under the bus" because she would have faced significantly more possible time without the benefits of a plea agreement. She was never indicted on the full list of offenses for which Jehangiri said she could have been prosecuted.

Tingle's final plea agreement only involved the health care fraud offense. Jehangiri said the U.S. didn't prosecute Tingle for additional offenses, including tax-related crimes, in exchange for Tingle's cooperation.

"It was a long-running, six-year fraud scheme," Jehangiri said. "... $500,000 was gone. There's really nothing to show for it other than paying for racing cars and paying other people's debts."

Tingle's attorney, Michael Butler, requested that Tingle's sentence be carried out as house arrest or another form of supervision rather than sending her to prison, where the current risk of Tingle contracting COVID-19 might be greater than the need for her to serve conventional time for her crime.

"She's not a senior citizen, but she's not a young person," Butler said, noting Tingle's lack of criminal history. "... I wouldn't be making this argument if I was next to a violent individual."

Schreier agreed to allow Tingle to self-surrender in 60 days to allow time for more information about the coronavirus to become available and to give the pandemic time to subside. Tingle will have to turn herself in to the facility where she will serve her sentence by May 15.

Schreier said she gave Tingle a sentence on the low end of the 30 to 37 month range recommended in a presentence investigation report because she took responsibility when she was caught, but she said Tingle owns multiple trailers and snowmobiles and that not selling them for money to put toward restitution indicated she had come to enjoy the standard of living that resulted from her embezzlement.

"Your embezzlement in this case was basically to allow you and your family to live beyond your means, and that shows criminal thinking," Schreier said.

Tingle apologized to members of her family, some of whom attended her sentencing.

"I disappointed them and embarrassed them in the community where we've lived our whole lives," she said. "I'm sorry to Firesteel and its residents."

Following her incarceration, Tingle will spend three years on supervised release. She was ordered to pay a $100 special assessment, but Schreier waived imposing any additional fines.