Guardian Elder Care, Guardian LTC Management, Guardian Rehabilitation Services, and Guardian Elder Care Management will pay $15,466,278 to resolve allegations of healthcare fraud. According to prosecutors, the companies, known collectively as Guardian, overbilled Medicare, and the Federal Employees Health Benefits Program for medically unnecessary services, in violation of the False Claims Act.
Guardian operates 69 facilities across three states, from Columbus, Ohio, to Fairmont, West Virginia. The company is headquartered in Brockway, Pennsylvania, and the majority of its facilities are also located in the keystone state.
According to its website, Guardian has six core values, “honesty, respect, compassion, dedication, unity, and accountability.” The Department of Justice would disagree with this self-description. Prosecutors claim that Guardian knowingly overbilled Medicare for medically unnecessary rehabilitation therapy services, falsely indicating that patients required the highest level of skilled therapy on numerous occasions over a period of seven years.
The alleged fraud came to light thanks to the courage of two former Guardian rehab managers, Philippa Krauss and Julie White, who are now set to receive a $2.8 million award for their efforts. The whistleblowers filed a lawsuit against Guardian under the False Claims Act, which enables tipsters to receive up to 30 percent of any taxpayer fund recoveries.
The whistleblowers worked at the Forest Park Healthcare & Rehabilitation Center in Carlisle, Pennsylvania. On its website, Guardian states that Forest Park Healthcare and Rehabilitation Center “isn't just a place; it is a philosophy of care, dedicated to preserving the dignity of our residents and to providing compassionate care.” Yet, according to Krauss and White, the company was more concerned with boosting profits than with preserving patients’ dignity.
According to the whistleblower complaint, Guardian “pressured” employees to inflate the level of skilled rehabilitation therapy required by patients to increase Medicare billings. Additionally, the rehab managers and their staff were allegedly pressured to “maximize the number of days billed to Medicare at the [highest reimbursement] level, regardless of medical necessity. . . increase average lengths of stay. . . plan the minimum number of minutes of therapy required to bill at the highest reimbursement level while discouraging the provision of therapy in amounts beyond that minimum threshold,” and “arbitrarily shift the number of minutes of planned therapy between different therapy disciplines to ensure targeted reimbursement levels were achieved,” among other violations.
The Department of Justice is actively targeting healthcare fraud in Skilled Nursing Facilities (“SNFs”), like the ones operated by Guardian. The government is committed to deterring service providers from overbilling Medicare for medically unnecessary rehabilitation therapy. Several investigations have shown that numerous SNFs are focusing on boosting profits rather than providing the services required by residents.
When this happens, both Medicare beneficiaries and taxpayers suffer. The U.S. Attorney for the Eastern District of Pennsylvania, William M. McSwain, said in a statement that “Too much rehabilitation therapy can actually harm patients, just like giving them too many pills or too much medicine. And, of course, it harms taxpayers who foot the bill for unnecessary treatment.”
A spokesperson for the Department of Justice commented that “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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