PITTSBURGH – U.S. Attorney Scott W. Brady announced Wednesday that Guardian Elder Care Holdings Inc. and its related companies will pay $15,466,278 to settle claims that the nursing home chain provided medically unnecessary rehabilitation therapy to residents in order to meet revenue goals, instead of clinical needs.
Guardian Elder Care, headquartered in Brockway, operates more than 50 facilities throughout Pennsylvania—including locations in Allegheny, Beaver, Clearfield, Fayette, Indiana, Jefferson, McKean and Westmoreland counties— as well as Ohio and West Virginia.
According to the U.S. Department of Justice, the settlement resolves allegations in a whistleblower complaint filed in federal court in the Eastern District of Pennsylvania under the qui tam provisions of the False Claims Act.
These provisions allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The whistleblowers, Philippa Krauss and Julie White, will share approximately $2.8 million of the recovery between them. Guardian Elder Care formerly employed both of these whistleblowers.
The whistleblowers generally alleged that Guardian Elder Care pressured its rehabilitation therapists to provide services to meet financial targets and maximize revenue without regard to clinical need.
For example, they said certain patients suffered from dementia and did not need or want rehabilitation therapy, but Guardian Elder Care pressured therapists to provide those services anyway to meet revenue goals.
It was also alleged that other patients were dying and receiving hospice care—and therefore had no medical need for intensive therapy—but Guardian Elder Care pressured therapists to treat those patients, as well, in order to meet the same financial goals.
Wednesday’s announced settlement agreement resolves the allegations arising from Guardian Elder Care’s facilities management practices from January of 2011 through December of 2017.
Additionally, while the government was investigating these allegations, it was noted that Guardian Elder Care voluntarily disclosed that it had employed two people who were excluded from federal healthcare programs.
According to the DOJ, the settlement therefore encompasses claims that Guardian Elder Care inappropriately received payment for services provided through these excluded persons during their term of exclusion.
The public can search the government’s database of excluded providers at the Web site: http://exclusions.oig.hhs.gov/.
“Billing federal healthcare programs for medically unnecessary rehabilitation services not only depletes these programs’ funds, but also exploits our most vulnerable citizens,” said Brady.
“Our office will continue to aggressively pursue providers who take advantage of our seniors by putting financial gain ahead of patient care.”
“Too much rehabilitation therapy can actually harm patients, just like giving them too many pills or too much medicine,” said U.S. Attorney William M. McSwain of the Eastern District of Pennsylvania.
“And of course, it harms taxpayers who foot the bill for unnecessary treatment. We thank Ms. Krauss and Ms. White for their role in bringing this alleged scheme to light.
“We also commend Guardian Elder Care for telling us about its employment of the excluded providers. It is in their best interest for companies to make voluntary disclosures and emphasize compliance going forward, as my office will take this sort of cooperation into consideration when determining an appropriate resolution.”
“Seniors rely on the Medicare program to provide them with appropriate care, and to ensure that they are treated with dignity and respect,” said Assistant Attorney General Jody Hunt of the Department of Justice’s Civil Division.
“The Department will not tolerate nursing home operators that put their own economic gain ahead of the needs of their residents, and will continue to hold accountable those operators who bill Medicare for unnecessary rehabilitation services.”
“Protecting our beneficiaries from unnecessary services is a priority and we will not tolerate companies putting financial gain ahead of quality of care,” said Maureen R. Dixon, Special Agent in Charge, Office of the Inspector General-U.S. Department of Health and Human Services (HHS-OIG).
“HHS-OIG will continue to work with our partners at the Department of Justice and OPM-OIG to root out fraud, waste and abuse in the Medicare and Medicaid programs.”
OPM OIG Deputy Assistant Inspector General for Investigations Thomas W. South, Deputy Assistant Inspector General for Investigations, said: “Subjecting vulnerable patients to unnecessary treatments for financial gain is unconscionable.
“First and foremost, OPM OIG prioritizes protecting Federal employees and their dependents from patient harm. I am proud that we were able to work with our law enforcement partners to hold Guardian Elder Care accountable for their unscrupulous behavior.”
In addition to the nearly $15.5 million payment, Guardian Elder Care agreed to enter into a chain-wide Corporate Integrity Agreement with the U.S. Department of Health and Human Services Office of Inspector General. Such agreements promote compliance and protect vulnerable nursing home residents.
Assistant U.S. Attorney Rachael L. Mamula handled this case in the Western District of Pennsylvania working jointly with Assistant U.S. Attorneys Michael S. Macko and Scott W. Reid in the Eastern District of Pennsylvania and Susan Lynch, Senior Counsel for Elder Justice, of the Civil Fraud Section of the Department of Justice, and with investigative assistance from auditor Dawn Wiggins.
The case was investigated by the U.S. Department of Health and Human Services Office of the Inspector General, and the U.S. Office of Personnel Management Office of Inspector General.
This case was supported by the Department of Justice’s Elder Justice and Nursing Home Initiative, which coordinates the department’s activities combating elder abuse, neglect, and financial exploitation, especially as they affect beneficiaries of Medicare, Medicaid and other federal health care programs.
For more information about the Department’s Elder Justice Initiative, see https://www.justice.gov/elderjustice/.
There has been no determination of civil liability, according to the DOJ, and the settled civil claims are allegations only.