PITTSBURGH – The former administrator of a Mount Lebanon skilled nursing home has been indicted by a federal grand jury in Pittsburgh on charges of conspiracy to defraud the United States, health care fraud and obstruction of a federal audit, United States Attorney Scott W. Brady and Pennsylvania Attorney General Josh Shapiro announced today.
The three-count Indictment, returned on February 24, 2021, named Susan Gilbert, age 60, of Lawrence, Pennsylvania, as the sole defendant.
"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."
"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."
According to the Indictment, from October 10, 2018 through February 20, 2020, Gilbert conspired with others to defraud the United States 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; and committed health care fraud and the obstruction of 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. The Indictment further alleges that Gilbert and/or other co-conspirators directed employees of MLRWC to falsify records to give the appearance that the facility met federal and state staffing requirements. MLRWC is part of an ownership structure that owns multiple long-term care facilities in Pennsylvania, including Brighton Rehabilitation and Wellness Center.
In addition, the Indictment alleges several schemes utilized in the conspiracy:
• Gilbert and/or other co-conspirators directed administrative and management-level nursing staff and other employees 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 Department of Health (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.
• 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.
"The FBI and our law enforcement partners will expose and hold accountable those who commit healthcare fraud," said FBI Pittsburgh Special Agent in Charge Michael Christman. "Health care fraud deprives patients of critical health care services and results in billions of dollars in losses that impacts everyone."
"This indictment shows that health care fraud is not a victimless crime. Falsifying records to avoid quality of care requirements can result in substandard, dangerous conditions for nursing home residents and a waste of taxpayer dollars," said Special Agent in Charge Maureen R. Dixon of the Health and Human Services Department Office of Inspector General. "Together with our law enforcement partners, we will continue to investigate such scams and hold accountable bad actors who ignore their responsibilities to patients and the vital programs designed to serve them."
"Today’s indictment is the byproduct of the cooperative efforts of IRS-Criminal Investigation and our law enforcement partners" said Thomas Fattorusso, Special Agent in Charge of IRS-Criminal Investigation. "Regulations governing the administration of nursing homes are put in place for a reason. Any attempt to skirt these regulations can have major consequences."
The law provides for a maximum total sentence of not more than ten years in prison, a fine of $250,000 or both. Under the Federal Sentencing Guidelines, the actual sentence imposed would be based upon the seriousness of the offenses and the prior criminal history, if any, of the defendant.
Assistant United States Attorneys Robert S. Cessar and Karen Gal-Or are prosecuting this case on behalf of the government.
The Federal Bureau of Investigation, the U.S. Department of Health & Human Services – Office of Inspector General, the Pennsylvania Office of Attorney General, and the Internal Revenue Service – Criminal Investigation conducted the investigation leading to the Indictment in this case.
An Indictment is an accusation. A defendant is presumed innocent unless and until proven guilty.
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February 25, 2021 at 11:17PM
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U.S. Attorney Scott Brady and Pennsylvania Attorney General Josh Shapiro Announce Indictment in Nursing Home Investigation - Department of Justice
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