Feds: Nursing home firm to pay $15.4 million in billing case

BROCKWAY (AP) — A Pennsylvania-based nursing home company that owns two facilities in the area has agreed to pay more than $15.4 million to resolve allegations of overbilling for medically unnecessary rehabilitation therapy services, federal authorities said Wednesday.

The Department of Justice said the False Claims Act allegations against Guardian Elder Care Holdings Inc., involved overbilling Medicare and the Federal Employees Health Benefits Program from 2011 through 2017. Guardian Elder Care owns Weatherwood Healthcare and Rehab Center in Weatherly and Brookmont Healthcare Center in Effort.

The company was accused of having had facilities in Pennsylvania, West Virginia and Ohio bill for patients at the highest level of Medicare reimbursement “when services at that level were not medically necessary and were influenced by financial considerations rather than resident needs,” federal authorities said.

“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.”

Two former Guardian employees who brought the allegations are to receive approximately $2.8 million, the department said.

The settlement also resolves allegations voluntarily disclosed by Guardian that it had employed two people who were excluded from federal health care programs. As a result of its employment of these two excluded individuals, Guardian inappropriately received payment for ineligible services.

“Billing federal health care programs for medically unnecessary rehabilitation services not only depletes these programs’ funds but also exploits our most vulnerable citizens,” said U.S. Attorney Scott W. Brady of the Western District of Pennsylvania. “Our office will continue to aggressively pursue providers who take advantage of our seniors by putting financial gain ahead of patient care.”

“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 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.”

Brockway, Pennsylvania-based Guardian, which operates more than 50 nursing facilities in Pennsylvania, Ohio and West Virginia, said resident care “remains our first priority and we are committed to meeting our obligations under this agreement.

“We are confident that Guardian’s corporate compliance program advocates for our patients, their families and caregivers,” Patricia McGillan, the company’s chief compliance officer, said in a statement.