Date: 09-20-2024

Case Style:

United States of America v. John H. Johnson; Paula Z. Johnson

Case Number: 1:24-cr-00045

Judge: Christopher C. Conner

Court: The United States District Court for the Middle District of Pennsylvania (Dauphin County)

Plaintiff's Attorney: The United States Attorney’s Office in Harrisburg

Defendant's Attorney:

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Description:

Harrisburg, Pennsylvania criminal defense lawyer represented the Defendant charged with Conspiracy To Defraud The United States And Health Care Fraud Conspiracy
Hollidaysburg Couple Sentenced For Conspiracy To Defraud The United States And Health Care Fraud Conspiracy

In 2016, John H. Johnson, a physician with specialized training in anesthesiology, entered into an agreement with other individuals to defraud health insurance programs by billing them illegally for expensive tests known as “urine drug tests.” One of the individuals that Johnson conspired with was Rodney L. Yentzer, who pleaded guilty for his role in related offenses in March 2022 and is awaiting sentencing. Johnson and Yentzer carried out this agreement through a couple different groups of pain management practices located throughout central Pennsylvania, known as Lighthouse Medical and Pain Medicine of York (“PMY”). Yentzer, who had no medical training, acquired PMY in 2014 at the suggestion of John H. Johnson, with whom Yentzer was business partners. PMY absorbed Lighthouse Medical in 2017, and PMY closed permanently in November 2019 after law enforcement agents executed search warrants at its various locations.

“Ensuring the integrity of health care programs in this age of rising costs is paramount to our mission,” said Maureen R. Dixon, Special Agent in Charge for the U.S. Department of Health and Human Services, Office of the Inspector General. “We will continue to work with federal, state, and local partners to hold providers accountable for misconduct that exploits the programs.”

“Healthcare fraud is not a victimless crime. In this case, the defendants caused taxpayers' hard-earned dollars to be diverted from patients who needed care, and instead served their own interests,” said Wayne A. Jacobs, Special in Agent in Charge of FBI Philadelphia. “Today’s sentencing demonstrates the FBI and our partners’ commitment to rooting out fraud and pursuing those who conspire to exploit our healthcare systems for financial gain."

In 2016, Lighthouse Medical, under the direction of John H. Johnson, operated a drug testing laboratory on its own premises. This laboratory had the equipment and capabilities to perform urine drug testing (“UDT”) on site. UDT, when used legitimately, is a method for physicians to test their patients for the presence and specific amounts of various substances. A very high percentage of the patients of Lighthouse Medical (and, subsequently, PMY) were prescribed with opioid medications at each monthly visit. UDT could be used, for instance, to test whether such patients were taking their medications as prescribed or taking illegal recreational drugs in addition to their prescribed medications. Urine drug tests were typically reimbursed at a high rate by Medicare and private insurance programs.

In March 2016, Johnson and Yentzer agreed with the new owners of a rural, 25-bed “Critical Access Hospital” located near the border of Florida and Alabama to “sell” Lighthouse Medical’s UDT laboratory services to the hospital; in exchange, the hospital purchased the exclusive right to bill for payment and collect payment from patients and insurance programs. The hospital agreed to pay Lighthouse Medical a kickback of $900 per test.

As a Critical Access Hospital under federal law, the hospital received very favorable payment from Medicare and private insurance programs, including, for example, for UDT. Thus, even while paying a $900 kickback per test to Lighthouse Medical, the hospital was still able to collect and keep a significant amount of money over and above that amount. The owners of the hospital also used other laboratories like Lighthouse Medical in a similar pass-through manner. As a result, the hospital was able to bill for a number of laboratory tests that far exceeded what would normally be associated with a small facility of its kind, and Lighthouse Medical was paid far more than what it would have typically received for UDT from Medicare and other insurers. For instance, on July 12, 2016, the hospital paid Lighthouse Medical $816,300 for 907 urine drug tests. Approximately one week later, the hospital paid Lighthouse Medical $628,200 for nearly 700 tests.

In total, the owners of the hospital billed others, including private insurers, approximately $1.4 billion for various laboratory testing services that were not medically necessary. The majority of this amount was due to UDT. Lighthouse Medical received $2,341,775 in kickback payments over a four-month time period, with 85% of this amount going to John H. Johnson and the remaining amount going to Rodney L. Yentzer.

Under the terms of his plea agreement, John H. Johnson will also be required to pay over $2.3 million in restitution to defrauded health insurance companies. The restitution order against John H. Johnson is expected to be finalized within the next sixty days.

In addition to pleading guilty to conspiracy to commit health care fraud, John H. Johnson pleaded guilty to one count of conspiracy to defraud the United States. His wife, Paula Z. Johnson, who is also a physician from Hollidaysburg, Pennsylvania, pleaded guilty to the same offense. Together, John H. Johnson and Paula Z. Johnson conspired to evade payments to the U.S. Government that John H. Johnson was required to make for a prior criminal conviction.

In July 2015, John H. Johnson was indicted for various tax offenses in the U.S. District Court for the Western District of Pennsylvania. In September 2016, John H. Johnson was charged in the U.S. District Court for the Southern District of Florida with conspiracy to commit mail fraud and wire fraud in connection with a separate health care fraud scheme. In early 2017, John H. Johnson knew that he was likely going to prison for these offenses, so he approached Rodney L. Yentzer and got Yentzer to agree to place Paula Z. Johnson, who had not practiced medicine in years, on the PMY payroll.

In June 2017, John H. Johnson was sentenced to an 84-month term of imprisonment for the various offenses with which he had been charged. He was also ordered to repay to the U.S. Government over $3 million restitution payments for fraudulent health care billing and unpaid taxes.

Even following his imprisonment, Johnson and Yentzer remained in close contact through phone and in-person visits, with Johnson providing direction to Yentzer. During conversations, Johnson and Yentzer sometimes used coded language to describe sensitive subjects, including the term “toy” to refer to money and the term “toy box” to refer to bank accounts.

John H. Johnson knew that PMY continued to be highly profitable, in large part owing to its UDT billing. Specifically, PMY billed every patient for two urine drug tests at each visit: one test a presumptive “screen” for the presence of certain substances and the second a definitive test for specific levels of 22 different substances. This testing protocol had been put in place by John H. Johnson when he ran Lighthouse Medical, and he instructed Yentzer to do the same at PMY. Yentzer followed this direction.

From mid-2017 until late 2019, PMY submitted bills just to Medicare for around $10 million in UDT, with well over $4 million being paid out. John H. Johnson, Paula Z. Johnson, and Rodney L. Yentzer devised various other ways to funnel money to the Johnsons so that they could benefit from this wealth without the money being captured for John H. Johnson’s restitution payments. Among other things, Yentzer purchased a car for the Johnsons’ son and leased an Audi Q5 for Paula Z. Johnson, at her request. Yentzer also made $28,000 in contributions to their children’s 529 college savings accounts, paid over $40,000 in legal bills for “asset and estate planning,” made over $40,000 in payments toward personal loans, and covered other large bills, all with the knowledge of both John H. Johnson and Paula Z. Johnson. On a number of occasions, Paula Z. Johnson requested these payments directly from Yentzer or his assistant.

PMY shut down abruptly in November 2019 after search warrants were executed because it was no longer able to retain medical providers to see patients. In January 2020, in a recorded prison call, Yentzer stated to John H. Johnson, that “if there’s anything left, I will make sure Paula gets, uh, a piece.” He added that “whatever’s left” after satisfying certain creditors he would “divvy up.” Yentzer made this statement despite the fact that Paula Z. Johnson had been formally terminated by PMY in November 2019.

The case was investigated by the U.S. Department of Health and Human Services Office of Inspector General, Federal Bureau of Investigation, Drug Enforcement Administration Diversion Control Division, and Pennsylvania Office of Attorney General. Assistant U.S. Attorney Ravi Romel Sharma prosecuted the case.

Outcome:

Defendant was found guilty and sentenced to

ohn Johnson received a sentence of 97 months in prison, followed by three years of supervised release.

Paula Johnson received a sentence of three years of probation, including six months of home detention with location monitoring, and was ordered to immediately pay $249,301.36 in restitution, fines, and assessments.

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