Pennsylvania Attorney General Dave Sunday announced that a Carbon County man pleaded no contest to multiple felonies after posing as a medical professional to administer care to patients and fraudulently bill Medicare, Medicaid, and private insurance companies.
The defendant, 44, pleaded no contest on February 14, 2025, in Carbon County Court to 17 felonies and one misdemeanor. A no-contest plea has the same legal effect as a guilty plea. He will be sentenced on May 12.
According to the Office of Attorney General investigation, the defendant posed as a physician, certified registered nurse practitioner (CRNP), or nurse at personal care homes and assisted living facilities, treating patients who believed he was a licensed medical professional. He prescribed medications (incorrectly) and performed procedures, including blood draws and injections, despite lacking any medical license or training.
In early 2022, the defendant and a local doctor agreed to jointly operate a business that would provide medical care to residents of these facilities. While the doctor believed the defendant was a registered nurse, the defendant’s role was supposed to be limited to managing business operations—not providing direct medical care. However, after the doctor became ill in September 2022, the defendant took advantage of the situation. He used the doctor’s cellphone and an authentication app (only accessible to physicians) to illegally prescribe controlled substances under the doctor’s name.
During this period, the defendant continued treating patients at multiple facilities, diagnosing conditions and prescribing medications without any medical training. For example, he prescribed diabetes medication to several patients who did not have the condition, causing them adverse effects.
In total, the defendant pleaded no contest to 13 counts of neglect (endangering the welfare of a care-dependent person), along with counts of Medicaid fraud, theft by deception, insurance fraud, identity theft, and practicing medicine without a license.
“The conduct involved here is egregious, in that the defendant put many people at risk by providing fraudulent care and prescribing medications, which had adverse effects,” Attorney General Sunday said. “The defendant’s pattern of deception also included defrauding the state Medicaid program, which enables in-need Pennsylvanians to acquire treatment and care.”
Compliance Perspective
Issue
It is illegal to practice a healthcare profession without a valid license or to misuse someone else’s license. Healthcare facilities receiving government funds are required to conduct comprehensive background checks on all employees. This includes criminal background checks, sex offender registry searches, identification verification, past employment history, education verification, and checking the Office of Inspector General’s (OIG) List of Excluded Individuals and Entities (LEIE). For positions requiring certifications or licenses, verification of these credentials must be documented in the individual’s personnel file. After hiring, databases should be continually monitored to ensure no employee has had their license suspended or revoked or has been added to the OIG’s exclusion list. Routine monitoring ensures that employees are legally permitted to practice healthcare in the facility.
Discussion Points
- Regularly review and update policies for verifying professional licenses and monitoring the OIG’s LEIE to ensure they meet current legal standards.
- Train relevant staff on protocols for verifying employee licenses and certifications both at the time of hire and on an ongoing basis. Licensed personnel should also be informed of their responsibility to maintain an active license and promptly notify administration if their license expires, is suspended, or if they are added to the OIG’s LEIE.
- Conduct periodic audits to confirm that employees’ licenses and certifications are valid and up to date. Ensure routine OIG LEIE checks are conducted. In addition to verifying credentials, watch for signs of fraud, such as:
- Altered or forged documents (e.g., driver’s license, insurance card)
- Mismatched photos, physical descriptions, or signatures
- Inconsistencies between forms of ID and company records (e.g., invalid SSN, fake address)
- Invalid or outdated contact information
- Missing or incomplete identifying information
- Conduct periodic audits to confirm that employees’ licenses and certifications are valid and up to date. Ensure routine OIG LEIE checks are conducted. In addition to verifying credentials, watch for signs of fraud, such as:
Immediately address any discrepancies or negative findings.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*
