February 19th, 2020
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., (Guardian) agreed to pay $15,466,278 to resolve False Claims Act allegations that they knowingly overbilled Medicare and the Federal Employees Health Benefits Program for medically unnecessary rehabilitation therapy services. Guardian operates more than 50 nursing facilities throughout Pennsylvania, as well as in Ohio and West Virginia.
“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.â€
The settlement resolves claims by the United States that from Jan. 1, 2011, through Dec. 31, 2017, Guardian caused 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 rather than resident needs. These allegations were originally brought by two former Guardian employees, Phillipa Krause and Julie White, under the whistleblower, or qui tam, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims and to share in any recovery. The whistleblowers in this case will receive approximately $2.8 million.
The settlement also resolves allegations voluntarily disclosed by Guardian that it had employed two people who were excluded from federal healthcare programs. As a result of its employment of these two excluded individuals, Guardian inappropriately received payment for ineligible services.
“Too much rehabilitation therapy can actually harm patients, just like giving them too many pills or too much medicine,†said U.S. Attorney William 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.â€
Contemporaneous with the civil settlement, Guardian 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. back...
“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.â€
The settlement resolves claims by the United States that from Jan. 1, 2011, through Dec. 31, 2017, Guardian caused 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 rather than resident needs. These allegations were originally brought by two former Guardian employees, Phillipa Krause and Julie White, under the whistleblower, or qui tam, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims and to share in any recovery. The whistleblowers in this case will receive approximately $2.8 million.
The settlement also resolves allegations voluntarily disclosed by Guardian that it had employed two people who were excluded from federal healthcare programs. As a result of its employment of these two excluded individuals, Guardian inappropriately received payment for ineligible services.
“Too much rehabilitation therapy can actually harm patients, just like giving them too many pills or too much medicine,†said U.S. Attorney William 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.â€
Contemporaneous with the civil settlement, Guardian 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. back...
