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Nursing Home Operator To Pay $15.4 Mln To Settle Over-billing Claims

nursinghome feb20 lt

A Pennsylvania nursing home chain has agreed to pay nearly $15.5 million to settle allegations that it overbilled Medicare and the Federal Employees Health Benefits Program for medically unnecessary rehabilitation therapy services, to meet its revenue targets.

The case's settlement, decided in the U.S. District Court for the Eastern District of Pennsylvania, requires Guardian Elder Care Holdings Inc., and related companies Guardian LTC Management Inc., Guardian Elder Care Management Inc., Guardian Elder Care Management I Inc., and Guardian Rehabilitation Services Inc. to pay $15,466,278 to resolve False Claims Act allegations.

Based in Brockway, Jefferson County, Guardian operates more than 50 nursing facilities throughout Pennsylvania, as well as in Ohio and West Virginia.

Two former employees of the nursing home - Phillipa Krause and Julie White filed a complaint on behalf of the government. The female whistleblowers will get $2.8 million from the settlement.

The Department of Justice said in a press release that over a period of seven years, starting from 2011, Guardian forced certain facilities in Pennsylvania, West Virginia, and Ohio to 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.

Assistant Attorney General Jody Hunt of the Department of Justice's Civil Division said 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.

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