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Catch of the Week: Guardian Elder Care

Posted  February 21, 2020

This week’s DOJ Catch of the Week goes to Guardian Elder Care.  On Wednesday, the operator of more than 50 nursing homes in Pennsylvania, Ohio and West Virginia agreed to pay roughly $15.5 million to resolve allegations it violated the False Claims Act by billing the government — Medicare and the Federal Employees Health Benefits Program — for medically unnecessary rehabilitation therapy services.  According to the government, Guardian billed for patients at the highest level of reimbursement, when services at that level were not medically necessary and were based on profit rather than patient need.  Read more here.

In announcing the settlement, the government stressed its commitment to going after healthcare fraud, especially where the elderly are the target of the wrongdoing:

Seniors rely on the Medicare program to provide them with appropriate care, and to ensure that they are treated with dignity and respect….  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.

​Billing federal healthcare programs for medically unnecessary rehabilitation services not only depletes these programs’ funds but also exploits our most vulnerable citizens…. Our office will continue to aggressively pursue providers who take advantage of our seniors by putting financial gain ahead of patient care.

The government’s allegations originated in a whistleblower suit filed under the qui tam provisions of the False Claims Act by former Guardian employees Phillipa Krause and Julie White.  They will receive a whistleblower award of roughly $2.8 million from the proceeds of the government’s recovery.  They also received the thanks and appreciation from the US Attorney in Philadelphia where they brought their case: “We thank Ms. Krauss and Ms. White for their role in bringing this alleged scheme to light.”  This whistleblower recognition is the product of a US Attorney’s Office (Eastern District of Pennsylvania) committed to promoting the critical role of whistleblowers and encouraging them to stand up and be heard.

The case was supported by DOJ’s Elder Justice and Nursing Home Initiative, which focuses on combating elder abuse, neglect, and financial exploitation.  It was also part of the Elder Justice Task Force of the U.S. Attorney’s Office for the Eastern District of Pennsylvania that launched four years ago.

Please contact us if you have information on fraud involving medically unnecessary services, medical billing, nursing homes, home health agencies, skilled nursing facilities, hospitals or other healthcare related activities and would like to speak to one of our experienced whistleblower attorneys.

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Tagged in: Catch of the Week, FCA Federal, Healthcare Fraud, Home Health and Hospice, Importance of Whistleblowers, Improper Medical Facility, Improper Medical Personnel, Medical Billing Fraud, Pharma Fraud, SNF, Whistleblower Case, Whistleblower Rewards,