Health Care Fraud
The U.S. Attorney’s Office places a high priority on criminal and civil enforcement in cases involving health care fraud and unauthorized health care benefits payments, as well as related activities such as fraud against the elderly and prescription drug fraud. The office works on these matters with the U.S. Department of Health and Human Services Office of the Inspector General (HHS-OIG), the Federal Bureau of Investigation, the Internal Revenue Service, the Drug Enforcement Administration, the Food and Drug Administration (FDA), the Office of the Pennsylvania Attorney General, District Attorney’s Offices within the Middle District, the Pennsylvania Department of State and the NEPA Insurance Fraud Task Force.
Anyone with information concerning suspected health care fraud or irregularities should contact the HHS-OIG at 1-800-HHS-TIPS (1-800-447-8477) and/or the U.S. Attorney’s Office at 717-221-4482, attention Assistant U.S. Attorneys Ravi Sharma (Criminal) or Tamara Haken (Civil), Health Care Fraud Coordinators.
Criminal Cases - Health Care Fraud
Florentina Mayko, age 39, of Cambria County, pleaded guilty on June 16, 2023, to defrauding Medicare by submitting medically unnecessary urine drug tests for chronic opioid patients at medical clinics where she was the chief executive officer, including a group of clinics known as Pain Medicine of York or “PMY” (also known as All Better Wellness). PMY billed Medicare for more than $10 million in urine drug tests and Medicare paid out over $4 million for these urine drug tests. The urine drug tests ordered by PMY were sent to an in-house laboratory at PMY whenever possible. As a result, when medically unnecessary tests were billed to Medicare, the proceeds from them went to PMY itself, according to the information.
Rodney L. Yentzer
On March 22, 2022, Rodney L. Yentzer, age 52, of Cumberland County, Pennsylvania, pleaded guilty to conspiracy to commit health care fraud, conspiracy to commit money laundering, and theft of public money for defrauding Medicare, Medicaid, and the U.S. Department of Health and Human Services between 2016 and 2020. Yentzer also agreed to pay $3,869,571.55 in restitution for these offenses. Yentzer agreed with others to defraud Medicare and Medicaid by submitting medically unnecessary urine drug tests for patients at clinics he controlled, including a group of pain clinics known as Pain Medicine of York or “PMY” (also known as All Better Wellness). PMY billed Medicare for more than $10 million in urine drug tests from mid-2017 through the end of 2019. As a result, Medicare paid out over $4 million for these urine drug tests. Pennsylvania’s Medicaid program was also billed for urine drug tests during this same time period. The urine drug tests ordered by PMY were sent to an in-house laboratory at PMY whenever possible. As a result, when medically unnecessary tests were billed to Medicare, the proceeds from them went to PMY itself. Yentzer is awaiting sentencing.
Dr. Raymond Kraynak, age 64, of Mt. Carmel, Pennsylvania, pleaded guilty on September 23, 2021, to 12 counts of unlawful distribution of a controlled substance. The guilty plea occurred after 13 days of trial testimony in the Williamsport federal courthouse and after the government rested its case-in-chief. Kraynak pled guilty to 12 counts of unlawful distribution and dispensing of a controlled substance outside the usual course of professional practice and not for legitimate medical purpose. Kraynak also admitted that the Schedule II narcotic opioid drugs that he prescribed resulted in the deaths of five of his patients. Kraynak was sentenced to a 15 year term of imprisonment and ordered to pay restitution in the amount of $22,365 to the victims or their families.
Kraynak was indicted by a federal grand jury on December 20, 2017, in a 19-count indictment charging unlawful distribution and dispensing of controlled substances, causing the death of five patients by the unlawful distribution and dispensing of controlled substances, and maintaining two drug-involved premises, one in Mt. Carmel and the other Shamokin, Pennsylvania. Kraynak stopped seeing patients and surrendered his license in December 2017 when he was arraigned in federal court on the indictment. Kraynak operated two offices, one in Mt. Carmel and the other in Shamokin, Pennsylvania, both known as Keystone Family Medicine Associates, and prescribed approximately 9.5 million units of oxycodone, hydrocodone, oxycontin and fentanyl to patients between January 2014 and July 31, 2017. The prosecution evidence included testimony from DEA analysts that Kraynak was the top prescriber of opioids in Pennsylvania in 2014, 2015, and 2016 and during those years prescribed more opioids than both the Veterans Medical Center in Pittsburgh and the Veterans Hospital in Philadelphia.
The prosecution’s evidence at trial also included testimony by a medical expert that Kraynak continued to prescribe high doses of opioids despite knowing that patients had previously been treated for drug overdoses, respiratory problems and other medical conditions increasing the risks of overdose and death. The prosecution’s evidence also established that Kraynak, in prescribing these opioids to multiple patients outside of the usual course of professional practice and without a legitimate medical purpose, and did so without conducting a proper medical examination, inadequately verifying the patient’s medical complaint, and failing to assess the risk of abuse by individual patients. Kraynak is awaiting sentencing.
Dr. Kurt Moran
Dr. Kurt Moran, age 70, of Scranton, Pennsylvania, was indicted on September 15, 2020, and pleaded guilty on December 6, 2021 to unlawful distribution of a controlled susbance, maintaining a drug-involved premises, and health care fraud. Moran was sentenced on September 1, 2022, to 140 months' imprisonment. Moran knowingly and intentionally distributed oxycodone and fentanyl, Schedule II controlled substances, outside the usual course of professional practice and not for legitimate medical purposes, and that the death of “J.B.” resulted from the use of the substances. With respect to the health care fraud scheme, between December 2014 and through 2017, Moran conspired with others to receive bribes in exchange for prescribing the drug Subsys (sublingual fentanyl) to his patients. Subsys is a transmucosal immediate release fentanyl (TIRF) drug. It is approved by the Food and Drug Administration (FDA) only for use in cancer patients suffering from breakthrough cancer pain. A company paid Moran approximately $140,000 over a two-year period to prescribe Subsys to his patients for pain not associated with cancer. In order to conceal and disguise that kickbacks and bribes were being paid to Moran to prescribe Subsys, the company falsely designated the payments to Moran as “honoraria” for purportedly providing educational presentations regarding Subsys. Moran prescribed millions of micrograms of the sublingual fentanyl spray to patients with no cancer diagnosis and not suffering from breakthrough cancer pain. Moran surrendered his DEA registration on September 18, 2020. His license to practice medicine in the Commonwealth of Pennsylvania was suspended on October 7, 2020. Forfeiture of illicit proceeds were also ordered forfeited by Judge Mariani and included unlawful proceeds in the amount of $140,000; his medical license; the contents of a bank account in the amount of $12,570.45; and $5,430.00 seized from Moran in January 2018. Restitution in the amount of $6,586.00 related to funeral expenses was also ordered.
Michael Timothy Buchanan
Michael Timothy Buchanan, age 68, of Indiana, was sentenced to 37 months's imprisonment on February 26, 2020 and ordered to pay $1,493,629 in restutition. Buchanan pleaded guilty on May 14, 2019, to defrauding a trust fund established by the Association of Pennsylvania State College and University Faculties (APSCUF) out of $1,493,629. Buchanan executed a scheme to defraud the Pennsylvania Faculty Health and Welfare Fund (The Fund) between 2007 and 2017 by his submission of false, inflated invoices for the services his company, Actuaries, Consultants and Administrators, Inc. (ACA), provided The Fund in connection with the processing of dental and vision claims submitted by members of the APSCUF Union.
Belinda Dietrich, a 63-year-old Marysville, Cumberland County woman was sentenced on October 28, 2019, to one year and a day of imprisonment for forging the signature of a dentist on 164 prescriptions for opioid drugs. Dietrich, a former receptionist for a solo dental practitioner forged the signature of her employer on a blank prescription form for oxycodone pills for her mother, a Medicare beneficiary, who was not a patient of the dentist. Dietrich then had the prescription filled at a Harrisburg area pharmacy and received 24 oxycodone pills, who then converted the drugs to her own use. The pharmacy billed the cost of the oxycodone pills to Medicare, which paid the claim.
On June 5, 2018, Dr. Fuhai Li, a 53-year-old physician licensed by the Commonwealth of Pennsylvania and authorized to prescribe Schedule II controlled substances, was found guilty by a federal jury of unlawfully prescribing oxycodone and other opioids to 23 former patients, including a Honesdale woman who died as a result of using the pills and a pregnant woman who gave birth to an opioid-dependent baby.
Li owned and operated the Neurology and Pain Management Center in Milford, Pike County, Pennsylvania. Between August 2011 and January 2015, Dr. Li wrote 26,985 prescriptions for Schedule II controlled substances, 99.37% of which were written for opioids. This included 18,115 prescriptions for oxycodone, of which 12,129 were written for oxycodone 30 milligrams, the highest dosage available in short acting oxycodone. Other opioids frequently prescribed by Dr. Li included methadone, OxyContin, hydrocodone and hydromorphone. Li repeatedly falsified patient medical records and made material omissions in those records in an effort to legitimize the unlawful prescriptions.
Former patients testified that they became addicted to opioids as a result of Li’s prescriptions. One patient testified she had sex with Li on almost every visit to his office during a four-year period and several former patients testified that they earned money by selling drugs prescribed to them by Li and used part of that money to buy heroin to support their addiction.
The jury also convicted Li of using two medical offices for the purpose of unlawfully prescribing opioids. Li was also convicted of tax evasion for the tax years 2011, 2012, and 2013 for underreporting his taxable income for those years by more than $800,000.
The jury’s verdict also included the forfeiture to the United States of $1,030,960 in cash that was seized from Li’s two residences; $1,036,079.36 seized from various bank accounts; real property located at 200 3rd Street, Milford (Li’s medical office); and real property located at 4005 Milford Landing Drive, Milford.
On April 3, 2019, Li was sentenced to 330 months' imprisonment.
Dr. Musaddiq Nazeeri
In November 2022, Dr. Musaddiq Nazeeri, of Lebanon, Pennsylvania, has agreed to pay the United States $86,506.30 to resolve civil liability for alleged violations of the False Claims Act. Between February 10, 2021 and January 21, 2022, Dr. Nazeeri billed Medicare for certain services that were not supported by the medical record. During the above timeframe, Dr. Nazeeri submitted Evaluation & Management (E&M) claims when the only service rendered was the administration of the COVID-19 vaccine. It is those type claims that were not supported by the medical record. Dr. Nazeeri cooperated with the investigation.
In November 2022, Waschko's Pharmacy agreed to pay the United States $210,000 in civil penalties for allegedly failing to comply with recordkeeping requirements of the Controlled Substances Act. A DEA inspection revealed that, between August 2019 and August 2021, Waschko’s Pharmacy failed to keep complete, timely, and accurate inventories and records regarding the receipt and dispensing of Schedule II, III, and IV controlled substances, including but not limited to oxycodone, amphetamine salts, buprenorphine/naloxone, and alprazolam. As a result of Waschko’s Pharmacy’s alleged actions and inactions, thousands of doses of controlled substances went unaccounted for. Waschko’s Pharmacy cooperated with the investigators and has since been placed under new ownership and hired a new pharmacist-in-charge. This settlement addresses the independent obligation of Waschko’s Pharmacy to ensure it has systems in place adequate to prevent improper dispensing, as required by 21 U.S.C. §§ 827, 842, and associated regulations.
Rodney L. Yentzer
In June 2022, Rodney Yentzer agreed to pay the United States $900,000 to resolve civil liability for alleged violations of the False Claims Act. Between 2017 and 2019, Yentzer, through a group of pain clinics he controlled known as Pain Medicine of York (PMY), caused the submission of false claims for payment to Medicare. Those claims were for presumptive and definitive Urine Drug Tests (UDTs) that were not medically reasonable or necessary and were not used to aid in the diagnosis and treatment of patients. Yentzer agreed to be excluded from all Federal health care programs for 22 years. Yentzer’s exclusion means that no Federal health care program payment may be made, either directly or indirectly, for any items or services furnished by Yentzer or at the direction or on the prescription of Yentzer.
Dr. Ahmed Khan
In April 2022, Dr. Ahmed Khan agreed to pay the United States $40,800 to resolve civil liability for alleged violations of the False Claims Act. Between 2019 and 2020, Dr. Khan accepted consultation fees for ordering Durable Medical Equipment (DME) and topical pain creams for patients with whom he did not have an established provider-patient relationship. He authorized orders for pre-selected products without any physical examination of the patients. In many instances, Dr. Khan had no interaction at all with the patients, and in some instances, he had only a brief phone call. Dr. Khan approved and signed orders for medically unnecessary DME (such as knee braces) and topical pain creams, in exchange for a small fee per patient from a third-party marketing company. As the prescribing physician, Dr. Khan played a key role in a larger telemedicine scheme that resulted in Medicare paying hundreds of thousands of dollars to DME companies and pharmacies for unnecessary products.
Geisinger Community Health Services
In November 2021, Geisinger Community Health Services (GCHS) agreed to pay $18,513,621.05 to resolve allegations of civil liability for submitting claims to Medicare for hospice and home health services that violated Medicare rules and regulations. GCHS voluntarily disclosed the violations. Between January 2012 and December 2017, through several affiliated entities, GCHS submitted claims to Medicare for hospice and home health services that violated Medicare rules and regulations regarding physician certifications of terminal illness, patient elections of hospice care, and physician face-to-face encounters with home health patients. After it discovered the problems, GCHS took corrective action and disclosed the matter to the United States Attorney’s Office.
Dr. Gina Sohn
In October 2021, Dr. Gina Sohn, a dentist practicing in South Korea, has agreed to pay the United States $100,000 to resolve civil liability for alleged violations of the False Claims Act. Dr. Sohn is a licensed dentist who practices in South Korea, serving U.S. military service members and their families. Between January 1, 2017 and January 1, 2021, Dr. Sohn allegedly submitted false or fraudulent claims for payment to the TRICARE Program for services not rendered to her patients, specifically for fillings not provided to patients. TRICARE is the healthcare program for uniformed service members, retirees, and their families around the world. The amount of the settlement represents the reimbursements received for the billings for unrendered services and penalties.
Physician's Mobile X-Ray Company
In August 2020, Physician’s Mobile X-Ray agreed to pay the United States $49,759 to resolve potential liability under the False Claims Act. Physician’s Mobile X-Ray is based in Harrisburg, Pennsylvania and provides mobile imaging services, including x-rays, ultrasounds and cardiac services. Physician Mobile X-Ray improperly billed Medicare for the transportation component of X-Ray equipment when x-ray services were provided to more than one Medicare beneficiary at the same location during the same trip. While Medicare will reimburse providers for a transportation component associated with mobile imaging services, that transportation component should be apportioned when more than one patient at the same location receives an x-ray during the same visit. The United States alleged that Physician’s Mobile X-Ray failed to apportion its charges between 2014 and 2019, leading to overcharges to Medicare.
Savage Family Pharmacy
In June 2020, Savage Family Pharmacy located in Waynesboro, PA, agreed to pay the United States $180,480 in civil penalties for allegedly failing to comply with recordkeeping and other requirements of the Controlled Substances Act. Between 2015 and 2019, Savage Family Pharmacy did not adequately monitor the conduct of its employees, and failed to keep complete and accurate inventories and records regarding the receipt and dispensing of Schedule II controlled substances, including but not limited to oxycodone and hydrocodone. These alleged violations enabled the altering of incoming inventory counts, as well as the altering of dispensed counts of the controlled substances over an extended period of time. Inventories, when conducted, were not reconciled with the perpetual log. Additionally, pages of the perpetual log were removed, allegedly, by an employee diverting the controlled substances. As a result of Savage Family Pharmacy’s alleged actions, tens of thousands of doses of controlled substances went unaccounted for and were potentially diverted for illicit purposes.