Pennsylvania Attorney General Josh Shapiro, in partnership with United States Attorney Scott Brady, announced the first indictment in relation to a nursing home investigation, Your Content has learned.
Pennsylvania Attorney General Josh Shapiro and U.S. Attorney Scott Brady today announced that the former administrator of Mount Lebanon Rehabilitation and Wellness Center, a sister nursing home to Brighton, has been indicted on federal charges. The charges are the result of a joint investigation in the federal grand jury, which alleges that the administrator directed employees to falsify records to give the appearance that the facility met federal and state staffing requirements. The administrator, Susan Gilbert, 60, is being charged with conspiracy to defraud the United States, health care fraud, and obstruction of a federal audit. This investigation is ongoing.
“These crimes put facility residents at risk by only providing a dangerously low amount of nursing staff just before COVID began to surge across the country,” said AG Shapiro. “By filing these false reports, the facility met minimum staffing levels only on paper — while Pennsylvanians who depended on them to care for their well-being didn’t have enough people to turn to. Our ongoing investigation will hold nursing and long-term care facilities criminally accountable wherever we find evidence someone neglected a resident. If you have information about a potential crime, contact my office at [email protected].”
According to the indictment, from October 10, 2018 through February 20, 2020, Gilbert conspired with others to defraud Pennsylvania of money and property by impeding, impairing, obstructing, defeating, and interfering with the lawful governmental functions of the U.S. Department of Health & Human Services in the administration of Medicare and Pennsylvania Medicaid; committed health care fraud; and obstructed a federal auditor.
The indictment alleges that Gilbert was the administrator of a skilled nursing home, Mount Lebanon Rehabilitation and Wellness Center (MLRWC), located in Allegheny County, Pennsylvania. MLRWC is part of an ownership structure that owns multiple long-term care facilities in Pennsylvania, including Brighton Rehabilitation and Wellness Center.
“These criminal charges represent the first step in holding accountable those who put profit over the health and safety of seniors,” said U.S. Attorney Brady. “From 2018-2020, Gilbert and co-conspirators deprived seniors of patient care using inflated nursing hours, falsified timecards and other schemes that they concealed with two sets of records. We will continue to pursue every lead until justice has been achieved for seniors and their families in western Pennsylvania.”
In addition, the indictment alleges several schemes utilized in the conspiracy:
- Gilbert and/or other co-conspirators directed administrative and management-level nursing staff, including, among others, the Director of Nursing, the Assistant Director of Nursing, and other administrative staff, to “clock in” for shifts but not actually work. In doing so, MLRWC created falsified timecard documentation that made it appear as though these individuals were providing direct resident care, when in fact they were not in the building and therefore not providing direct resident care;
- Gilbert and/or other co-conspirators caused management-level nursing staff to be paid monetary bonuses to “clock in” for shifts they did not actually work;
- Gilbert and/or other co-conspirators directed MLRWC staff not to clock in and out when they left the facility for their 30-minute lunch breaks. In doing so, MLRWC created falsified timecard documentation that made it appear as though these individuals were providing direct resident care during their lunch breaks, even when they were not in the building and not providing direct resident care;
- Gilbert and/or other co-conspirators directed MLRWC staff to include the hours worked by management-level nursing staff and other administrative staff on three-week staffing sheets provided to DOH, when in fact those employees did not provide direct resident care during the dates and hours listed;
- Gilbert and/or other co-conspirators caused administrative staff to keep two sets of books reflecting staffing levels. One book contained accurate information regarding the actual hours nursing staff provided direct resident care while the other contained falsified information that made it appear as though MLRWC had higher staffing levels;
- Gilbert and/or co-conspirators directed administrative staff to provide the falsified staffing documents to DOH investigators during the course of federally mandated inspections to make it appear as though MLRWC met federal and state mandated staffing requirements; and
- Gilbert and/or other co-conspirators engaged in the above-described acts in order to make it appear as though the facility was in compliance with the conditions of participation for Medicare and PA Medicaid, including the condition that the facility had “sufficient” nursing staff to meet residents’ needs and that the facility was operating and providing services in compliance with all applicable Federal, State, and local laws, regulations, and codes.
Gilbert could face up to ten years in prison, a fine of $250,000, or both.
Agents from the Office of Attorney General Medicaid Fraud Control Section investigated the case in collaboration with partners at the Federal Bureau of Investigation, the Office of Inspector General at the U.S. Department of Health & Human Services, and the Criminal Investigation section of the Internal Revenue Service.
Assistant United States Attorneys Robert S. Cessar and Karen Gal-Or are prosecuting this case on behalf of the government. All charges are accusations. The defendant is presumed innocent unless and until proven guilty.