Skip to main content

Analysis

Guardian Elder Care to Pay $15.4M to Settle Overbilling Allegations

By John Commins  
   February 20, 2020

Guardian directed its nursing facilities in Pennsylvania, West Virginia, and Ohio to upcharge Medicare at the highest level for medically unnecessary services.

Guardian Elder Care will pay $15.4 million to settle whistleblower allegations that its nursing facilities in three states knowingly overbilled Medicare for six years by providing unneeded rehabilitation services, the Department of Justice said.

"The department will not tolerate nursing home operators that put their own economic gain ahead of the needs of their residents, and will continue to hold accountable those operators who bill Medicare for unnecessary rehabilitation services," Assistant Attorney General Jody Hunt of the DOJ's Civil Division, said in a media release.

According to federal prosecutors, from 2011 through 2017 Brockway, PA-based Guardian  directed its nursing facilities in Pennsylvania, West Virginia, and Ohio to upcharge Medicare at the highest level, even when the services were not medically necessary and were prompted more by financial considerations than residents' needs.

The allegations were originally brought by two former Guardian employees, who will split $2.8 million from the settlement.

The settlement also resolves allegations voluntarily disclosed by Guardian that it received inappropriate payments for ineligible services because the company had employed two people who were excluded from federal healthcare programs.  

In prepared remarks, Patricia McGillan, Guardian Elder Care's Chief Compliance Officer, said the company is "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," she said.
 

“The department will not tolerate nursing home operators that put their own economic gain ahead of the needs of their residents. ”

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

Photo credit: Mark Van Scyoc / Shutterstock.com


KEY TAKEAWAYS

Proscutors said the upcharges to Medicare were prompted more by financial considerations than residents' needs.

The allegations were originally brought by two former Guardian employees, who will split $2.8 million from the settlement.

Guardian Elder Care operates more than 50 nursing facilities in Pennsylvania, West Virginia and Ohio.


Get the latest on healthcare leadership in your inbox.