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PA Nursing Home Admin Indicted On Federal Charges For Health Care Fraud

The former administrator of a Pennsylvania nursing home has been indicted on federal charges of health care fraud, state authorities said.

Mount Lebanon Rehabilitation and Wellness Center,

Mount Lebanon Rehabilitation and Wellness Center,

Photo Credit: Google Maps

Susan Gilbert, 60 -- Mount Lebanon Rehabilitation and Wellness Center, a sister nursing home to Brighton -- has been charged with conspiracy to defraud the United States, health care fraud, and obstruction of a federal audit, Pennsylvania Attorney General Josh Shapiro and U.S. Attorney Scott Brady said Thursday.

Gilbert is accused of directing employees to falsify records to give the appearance that the facility met federal and state staffing requirements, Shapiro and Brady said.

She and other co-conspirators directed administrative and management-level nursing staff, including the Director of Nursing, the Assistant Director of Nursing, and other administrative staff, to “clock in” for shifts but not actually work between October 2018 and February 2020, the indictment says. 

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, according to the indictment.

Gilbert and other co-conspirators caused management-level nursing staff to be paid monetary bonuses to “clock in” for shifts they did not actually work, authorities said.

They directed MLRWC staff not to clock in and out when they left the facility for their 30-minute lunch breaks, thus creating 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 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, Shapiro and Brady allege.

They 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, authorities said.

Gilbert and others 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, authorities said.

They 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 indictment reads.

According to the indictment, 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.

“These criminal charges represent the first step in holding accountable those who put profit over the health and safety of seniors,” Brady said. 

"We will continue to pursue every lead until justice has been achieved for seniors and their families in western Pennsylvania.”

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.

“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,” Shapiro said. 

“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 neglect-COVID@attorneygeneral.gov.”

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