RIDGEVIEW

Ridgeview Health Care and Rehabilitation in Curwensville was one of many Brockway-based Guardian Elder Care skilled care facilities that charged insurance companies for inappropriate therapy.

PITTSBURGH — United States Attorney Scott W. Brady announced Wednesday that Guardian Elder Care Holdings, Inc. and its related companies will pay $15,466,278 to settle claims that the skilled nursing home chain provided medically unnecessary rehabilitation therapy to residents in order to meet revenue goals, instead of clinical needs. Guardian Elder Care, headquartered in Brockway, operates more than 50 facilities throughout Pennsylvania — including locations in Allegheny, Beaver, Clearfield, Fayette, Indiana, Jefferson, McKean and Westmoreland counties—as well as Ohio and West Virginia.

Locally, Guardian Elder Care operates Mountain Laurel Healthcare and Rehabilitation Center, a 240-bed skilled nursing facility located at 700 N. Leonard St., Clearfield. It also operates Ridgeview Elder Care Rehabilitation Center at 30 4th Ave. in Curwensville, and Marion Manor assisted living facility at 1223 Schofield St, also in Curwensville. Only the Ridgeview Elder Care location was named in the lawsuit.

The settlement resolves allegations in a whistleblower complaint filed in federal court in the Eastern District of Pennsylvania under the qui tam provisions of the False Claims Act. These provisions allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The whistleblowers, Philippa Krauss and Julie White, will share approximately $2.8 million of the recovery between them. Guardian Elder Care formerly employed both of these whistleblowers.

The whistleblowers generally alleged that Guardian Elder Care pressured its rehabilitation therapists to provide services to meet financial targets and maximize revenue without regard to clinical need. For example, they alleged that certain patients suffered from dementia and did not need or want rehabilitation therapy, but Guardian Elder Care allegedly pressured therapists to provide those services anyway to meet revenue goals.

Other patients were allegedly dying and receiving hospice care — and therefore had no medical need for intensive therapy — but Guardian Elder Care allegedly pressured therapists to treat those patients, as well, in order to meet the same financial goals. Today’s announced settlement agreement resolves the allegations arising from Guardian Elder Care’s facilities management practices from January 2011 through December 2017.

Additionally, while the government was investigating these allegations, Guardian Elder Care voluntarily disclosed that it had employed two people who were excluded from federal healthcare programs. The settlement therefore encompasses claims that Guardian Elder Care inappropriately received payment for services provided through these excluded persons during their term of exclusion. The public can search the government’s database of excluded providers at the website: http://exclusions.oig.hhs.gov/.

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

“Too much rehabilitation therapy can actually harm patients, just like giving them too many pills or too much medicine,” said United States Attorney William M. 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.”

In addition to the nearly $15.5 million payment, 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.