Guardian Elder Care therapy company pays $15.4 Million to settle False Claims Act case for billing medically unnecessary Rehab services to Medicare

Guardian Elder Care Holdings Inc., and related companies Guardian LTC Management Inc., Guardian Elder Care Management Inc., Guardian Elder Care Management I Inc., and Guardian Rehabilitation Services Inc., (Guardian) agreed to pay $15,466,278 to resolve False Claims Act allegations that they knowingly overbilled Medicare and the Federal Employees Health Benefits Program for medically unnecessary rehabilitation therapy services, the Department of Justice announced today.  Guardian operates more than 50 nursing facilities throughout Pennsylvania, as well as in Ohio and West Virginia.

The settlement announced today resolve claims by the United States that from Jan. 1, 2011, through Dec. 31, 2017, Guardian caused certain facilities in Pennsylvania, West Virginia, and Ohio to bill for patients at the highest level of Medicare reimbursement, when services at that level were not medically necessary and were influenced by financial considerations rather than resident needs.  These allegations were originally brought by two former Guardian employees, Phillipa Krause and Julie White, under the whistleblower, or qui tam, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims and to share in any recovery.  The whistleblowers in this case will receive approximately $2.8 million.

The settlement also resolves allegations voluntarily disclosed by Guardian that it had employed two people who were excluded from federal healthcare programs. As a result of its employment of these two excluded individuals, Guardian inappropriately received payment for ineligible services. The whistleblowers were represented by Faruqui & Faruqui in Pennsylvania,

“Protecting our beneficiaries from unnecessary services is a priority and we will not tolerate companies putting financial gain ahead of quality of care,” said Maureen R. Dixon, Special Agent in Charge, Office of the Inspector General-U.S. Department of Health and Human Services (HHS-OIG).  “HHS-OIG will continue to work with our partners at the Department of Justice and OPM-OIG to root out fraud, waste and abuse in the Medicare and Medicaid programs.”

“Subjecting vulnerable patients to unnecessary treatments for financial gain is unconscionable,” said Deputy Assistant Inspector General for Investigations Thomas W. South, Office of the Inspector General-U.S. Office of Personnel Management (OPM-OIG).  “First and foremost, OPM-OIG prioritizes protecting Federal employees and their dependents from patient harm.  I am proud that we were able to work with our law enforcement partners to hold Guardian Elder Care accountable for their unscrupulous behavior.”

Contemporaneous with the civil settlement, 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.

Jeffrey Newman represents whistleblowers nationwide. He represented the whistleblower in the case of U.S. and Relator Janet Halpin versus RehabCare Inc which settled for $125 million. 617-823-3217

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