Pa. elder care chain to pay $15 million settlement over false Medicare claims
An elder care company has agreed to pay $15 million for allegedly filing false Medicare claims in over 20 of its facilities.
In a settlement agreement with the U.S. Department of Justice that was reached Wednesday, Guardian Elder Care agreed to pay $15,466,278 within 20 days. The agreement includes $6,261,070 in restitution.
Guardian Elder Care was accused of pressuring its rehabilitation therapists to provide therapy services to meet financial targets and maximize revenue without regard to the clinical needs of patients, resulting in the submission of false claims. For example, if a patient suffered from dementia and allegedly did not need or want rehabilitation therapy, the Jefferson County-based company allegedly pressured therapists to provide them with therapy to meet revenue goals.
From Jan. 1, 2011, to Dec. 31, 2017, the company provided those “ultra high” group rates that were not medically necessary at 28 facilities in Pennsylvania, Ohio and West Virginia including Scottdale Manor Rehab Center in Westmoreland County.
Guardian Elder Care owns Uniontown Healthcare and Rehabilitation Center in Fayette County, Havencrest Healthcare and Rehabilitation Center in Monongahela in Washington County and Waynesburg Healthcare and Rehabilitation Center in Greene County, but those facilities were not named in court documents.
“Billing federal healthcare 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. “Our office will continue to aggressively pursue providers who take advantage of our seniors by putting financial gain ahead of patient care.”
During the investigation, the company voluntarily disclosed that it had employed two people who were excluded from federal health care programs, but were receiving payments for services provided during their term of exclusion.
The company will also have to pay 5% interest on the settlement totaling approximately $2.8 million to be paid to Philippa Krauss and Julie White, the two company employees who alerted the government of the incidents.
Also, the company will also have to pay $535,000 in costs and attorney’s fees to Krauss and White.
“We thank Ms. Krauss and Ms. White for their role in bringing this alleged scheme to light,” said U.S. Attorney William M. McSwain. “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.”
There has been no determination of civil liability in the case, and the settled civil claims are only allegations, Brady noted.