JEFFERSON COUNTY, Pa. (WTAJ) — Guardian, headquartered in Brockway, Jefferson County, will have to pay $15,466,278 in claims after whistleblowers alleged that Guardian Elder Care pressured its rehab therapists to provide unneeded services to “meet financial targets” and to “maximize revenue without regard to clinical need”
U.S. Attorney Scott Brady announced that Guardian Elder Care Holdings, Inc. and it’s related companies have agreed to settle claims that they provided unnecessary rehabilitation therapy to residents in order to meet revenue goals instead of the actual clinical needs.
Two whistleblowers were former employees from a Guardian location in Carlisle, Pennsylvania.
They alleged that patients with dementia and even those in hospice, who had no medical need for the therapy would receive it after Guardian would pressure the therapists.
“Billing federal healthcare programs for medically unnecessary rehabilitation services not only depletes these programs’ funds but also exploits our most vulnerable citizens. Our office will continue to aggressively pursue providers who take advantage of our seniors by putting financial gain ahead of patient care.”Scott Brady, United States Attorney
While the government was investigating these allegations, Guardian disclosed that it had employed two people who were excluded from Medicare and federal healthcare programs.
“It’s important that facilities, any facility really, but especially nursing homes and assisted living facilities make sure their staff are able to engage in services that are able to be reimbursed,” Brady said in a phone interview.
In addition to the $15 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.
“What this means is they now have reporting obligations and benchmarks that they have to maintain during the pendency of this agreement to demonstrate to HHS that they are complying with this corporate integrity agreement and that these kinds of services and fraudulent billing practices are not engaged in,” Brady said.
Guadian said the following about the settlement and allegations:
“Resident care remains our first priority and we are committed to meeting our obligations under this agreement. We are confident that Guardian’s Corporate Compliance Program advocates for our patients, their families and caregivers.”Patricia McGillan, Guardian Elder Care Chief Compliance Officer
Guardian Elder Care operates more than 50 facilities throughout Pennsylvania, including Allegheny, Beaver, Clearfield, Fayette, Indiana, Jefferson, McKean, and Westmoreland counties, and also in Ohio and West Virginia.
The Department of Justice says the claims were not isolated to specific nursing facilities, but was happening company-wide.