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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 Kim Douglas Daniel (Criminal) or Melissa Swauger (Civil), Health Care Fraud Coordinators.

Recent Cases

Criminal Cases - Health Care Fraud

Fuhai Li

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.

Li was detained pending his October 3, 2018 sentencing date.

Charles J. Gartland

On August 14, 2018, Charles J. Gartland, D.O., age 59, of Cochranville, Pennsylvania, was sentenced to two years probation and ordered to pay restitution in the amount of $1,439.93 to Division of Medicare Services and $2,966.17 to Wellspan Health. Gartland previously pleaded guilty to perpetrating a scheme to defraud two health care benefit programs, WellSpan Health of York, PA and Medicare, by writing 221 prescriptions between September 2014 and August 2017, for Hydrocodone, Oxycodone, Fentanyl, Morphine and other controlled substances.  The prescriptions were issued by Gartland under the names of three of his family members. Of the 221 prescriptions, 194 were for 17,187 Hydrocodone-Ibuprofen 7.5 -200 mg pills.  The prescriptions were never intended for the medical care or treatment of the family members, but instead were intended for Dr. Gartland’s personal use.  

Raymond Kraynak

Dr. Raymond Kraynak, age 60, of Mt. Carmel, Pennsylvania, was indicted by a federal grand jury on December 20, 2017.  The 19-count indictment alleges that Kraynak, who operated two offices in Mt. Carmel and Shamokin, Pennsylvania, known as Keystone Family Medicine Associates, prescribed approximately 2.7 million units of oxycodone, hydrocodone, oxycontin and fentanyl to approximately 2,838 patients between January 2016 through July 31, 2017.  During that time period, he was the top prescriber of those drugs in the Commonwealth of Pennsylvania. It’s also alleged that Dr. Kraynak caused the death of five of his patients between 2013 and 2015 by unlawfully distributing and dispensing controlled substances to them that ultimately led to their death. Trial is tentatively scheduled for January 2019.

Joan Cicchiello

Joan Cicchiello, age 67, of Annville and Mount Carmel, Pennsylvania, was sentenced on May 9, 2018, to 72 months’ imprisonment and three years of supervised release on Health Care Fraud related charges.  Cicchiello, a licensed Certified Registered Nurse Practitioner and Registered Nurse who is certified by the Commonwealth of Pennsylvania, was the owner and operator of Twilight Beginnings, located in Mount Carmel, that provided mental health services.  Cicchiello used her company to recruit individuals who were either not properly licensed or unlicensed and have them “provide” psychiatric care to patients.  Despite the fact that Cicchiello knew these individuals were not trained, licensed nor authorized to provide these psychiatric related services, Cicchiello directed that they meet with elderly residents of nursing homes throughout central and northeastern Pennsylvania, as well as with adolescents seeking psychiatric care at her Mount Carmel, Pennsylvania office.  These individuals, whom Cicchiello referred to as her “counselors,” included a retired chiropractor, a convicted felon whose clinical social worker license was suspended, and numerous other unqualified individuals.  Cicchiello directed these individuals provide to her with a listing of the patients they met.  Cicchiello then utilized these lists to falsely bill the Medicare program as though she, a properly licensed and trained practitioner, personally provided face-to-face psychotherapy related services to the adolescent and elderly patients. 

Pauline M. Wolfe, et al.

On June 26, 2018, a federal grand jury returned four indictments charging ten residents of Cumberland and Perry County with obtaining possession of oxycodone, a Schedule II Controlled Substance, by misrepresentation, fraud and forgery.  Charged in the indictments are:

  • Pauline M. Wolfe, age 62, of Carlisle, PA;
  • Bruce A. Greenwald, age 40, Mechanicsburg, PA;
  • Angela L. Greenwald, age 40, Mechanicsburg, PA;
  • Charles J. Greenwald, age 31, of Carlisle, PA;
  • Heather Amanda Wolfe, age 27, of Carlisle, PA;
  • Megan Nico Bergstresser, age 31, Carlisle, PA;
  • Amy Beth Jones, age 32, Mechanicsburg, PA;
  • Joseph Benjamin Shatto, age 28, of Carlisle, PA;
  • Melissa L. Hunsicker, age 43, of Enola, PA;
  • David Allen Hunsicker, age 48, of Dillsburg, PA.

The indictments allege that between December 2016, and June 2017, the defendants conspired with each other and others to create false, fraudulent and forged prescriptions for oxycodone. Several of the defendants were also charged with making false statements in connection with payment of health care benefits. The indictment also alleges several defendants used the Medicare and Medicaid program benefits to pay for the forged prescriptions they filled at area pharmacies. At least three of the defendants stole the identities of Medicare and Medicaid beneficiaries to obtain payment for the fraudulently obtained opioids. The conspiracy is alleged to have resulted in the unlawful possession of approximately 10,000 oxycodone tablets. Trial is scheduled for October 2, 2018.

Robert Stremmel
 
Dr. Robert L. Stremmel, age 74, of York, Pennsylvania was indicted on June 27, 2018, by a federal grand jury with dispensing opiates and amphetamines outside the course of a professional practice and not for a legitimate medical purpose. The indictment alleges that Stremmel was licensed to practice medicine in the Commonwealth of Pennsylvania and had a medical office in York.  It is alleged that between July 2013 and January 2018, Stremmel distributed to one person more than 21,000 tablets of oxycodone and dextroamphetamine-amphetamine, both Schedule II controlled substances. The indictment also charges Stremmel with prescribing Xanax, codeine, and Tramadol, Schedule IV and V controlled substances. It is alleged that Stremmel intentionally prescribed these controlled substances outside the usual course of professional practice and not for a legitimate medical purpose. The indictment further charged Stremmel with making a false statement related to a health care matter for allegedly falsifying medical records in conjunction with a Medicare claim.  Trial is scheduled for November 5, 2018.

Civil Cases

Charles Cole Memorial Hospital

On May 4, 2018, Charles Cole Memorial Hospital, a Pennsylvania nonprofit corporation in Coudersport, Pennsylvania, agreed to pay the United States $373,547.54 to settle allegations from two self-disclosures by Charles Cole to the Office of Inspector General for the United States Department of Health and Human Services (OIG) through the OIG’s Provider Self-Disclosure Protocol.  The first self-disclosure and the investigation that followed, from August 1, 2007, through December 2013, alleged that Charles Cole failed to bill under a particular modifier to reduce the Medicare reimbursement amount for services provided by physician assistants and nurse practitioners in its pain management, orthopedics, gastroenterology, and medical oncology physician office practices.  According to the second self-disclosure and the investigation that followed, Charles Cole failed to perform required face-to-face encounters with some of its Medicare hospice patients prior to the third benefit period recertification and every subsequent benefit period re-certification from January 1, 2001 through February 1, 2014. Charles Cole has since taken corrective action and voluntarily disclosed these matters.  This settlement resolves the matter without the filing of litigation.

Leroy Pelicci

On April 5, 2018, the Estate of Dr. Leroy Pelicci agreed to pay the United States $625,000 to settle False Claims Act allegations. Leroy J. Pelicci was a physician and owner of the Pelicci Pain Relief Center in Scranton, Pennsylvania until his death in March 2014.  The United States alleged that Dr. Pelicci submitted numerous improper claims for payment to the Department of Labor Office of Workers’ Compensation Programs under the Federal Employees Compensation Act and the Federal Employees Health Benefits Program for trigger point injections, which were upcoded to receive a higher reimbursement amount than permitted, between June 11, 2003 and March 4, 2014.  The settlement reflects the amount of loss to the Government as a result of these allegations, as well as the costs of the investigation.

 

Updated September 11, 2018

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