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Nursing home company in Bethlehem and Quakertown pays $15.5 million to settle claims over unnecessary therapy
Morning Call - 2/20/2020
Feb. 20--A whistleblower lawsuit by two employees of a Pennsylvania nursing home company led to a $15.5 million settlement to resolve claims that it provided medically unnecessary rehabilitation therapy to residents, federal prosecutors announced Wednesday.
The whistleblowers alleged Guardian Elder Care Holdings pressured rehabilitation therapists to meet financial goals and generate revenue by providing treatment regardless of whether it was needed. Residents who suffered dementia and did not need or want rehabilitative therapy were treated anyway, the lawsuit alleged.
Guardian also pressured employees to provide therapy to patients who were dying and receiving hospice care, the suit alleged.
"Too much rehabilitation therapy can actually harm patients, just like giving them too many pills or too much medicine," U.S. Attorney William M. McSwain said. "And of course it harms taxpayers who foot the bill for unnecessary treatment."
The company operates nursing homes in Bethlehem, Effort, Quakertown and elsewhere in Pennsylvania, Ohio and West Virginia. Court documents did not specify in which of Guardian's 69 facilities the alleged fraud occurred.
Guardian's chief compliance officer, Patricia McGillan, said in a statement that the company's compliance program advocates for patients and their families.
"Resident care remains our first priority and we are committed to meeting our obligations under this agreement," McGillan said.
In addition to the $15.5 million payment, Guardian entered into a corporate integrity agreement with the Health and Human Services Office of Inspector General. Such agreements promote compliance and protect vulnerable nursing home residents, the U.S. attorney's office said.
The suit, filed under the federal False Claims Act in U.S. District Court in Philadelphia, alleged Guardian fraudulently billed Medicare from January 2011 through December 2017.
The whistleblowers, former rehabilitation manager Philippa Krauss and therapist Julie White, will share $2.8 million of the money Guardian is returning to the government. Both women worked in Guardian's rehabilitation facility in Carlisle, Cumberland County, according to the lawsuit.
During the government's investigation, Guardian also revealed that it had employed two people who were excluded from the Medicare program. The U.S. Department of Health and Human Services excludes people and companies who have been convicted of Medicare fraud from receiving payment under the program.
The case was investigated by the of Health and Human Services Office of Inspector General. It was handled jointly by prosecutors from the U.S. attorneys' offices in Philadelphia and Pittsburgh and the civil fraud section of the Justice Department.
Morning Call reporter Peter Hall can be reached at 610-820-6581 or firstname.lastname@example.org.
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