The companies were found guilty of healthcare fraud in late 2023.
Mt. Lebanon Operations LLC and Comprehensive Healthcare Management Services LLC, the owners and operators of multiple Pittsburgh-area nursing facilities including Brighton Rehabilitation and Wellness Center, will owe $15 million in restitution after being found guilty of healthcare fraud in late 2023. Acting U.S. Attorney Troy Rivetti of the Western District of Pennsylvania, said the companies had been engaging in the fraud for some time, and that trial evidence showed they falsified records later sent to the Pennsylvania Department of Health.
“Protecting the health, safety, and dignity of the residents of these nursing facilities and ensuring adequate staff to care for these vulnerable resident populations has been our office’s primary focus and objective throughout this prosecution,” said Acting U.S. Attorney Rivetti. “Choosing to prioritize profits over patient care, these facilities lied and falsified records regarding meeting minimum requisite staffing levels to avoid sanctions and to continue to receive federal funding, all the while failing to provide residents with the level and quality of care they deserved.” The Brighton facility in particular became one of the hardest hit areas in Pittsburgh during the COVID-19 pandemic, prompting the National Guard to send almost 40 members to assist.
U.S. District Judge Robert J. Colville handed out the sentence nearly a year and a half after the facilities were initially found guilty of fraud. Colville did acknowledge however that one of the two companies was already bankrupt, with the second nearly bankrupt, so neither has the ability to pay. Comprehensive Healthcare Management Services owes the government approximately $12.6 million, while Mt. Lebanon Operations owes just under $3 million. The sentences were handed out despite objections from defense attorneys representing both companies, arguing any judgment requiring restitution would not be able to be paid, and that the government never proved its entitlement.
“The government has never been able to show that it suffered any pecuniary loss in this case, except by speculative leaps that lack any basis in fact and contradict the testimony of its own witnesses at trial,” a memo from the defense read. It also argued the government could not prove that Medicaid or Medicare would have paid for any of the medical treatments provided at a different facility.
The indictment, which was initially filed on behalf of the U.S. government in 2022, allegedly detailed years of Medicaid and Medicare malpractice or fraud. It argued that the facilities would doctor records to make it appear as though there were an appropriate number of doctors on staff to meet state requirements and then manipulate health records of patients to increase the reimbursements owed to them by entitlement programs. The companies were also accused of accepting more residents than it could reasonably accommodate and then failing to have the appropriate staff available to care for the residents.
The filing also detailed incidents that arose from the lack of staffing, in particular an elderly female resident who was violently assaulted by a male resident reportedly suffering from advanced dementia. There were no nursing home staff members on site at the time that could prevent the incident, nor provide timely treatment to the woman, causing her injuries to be more extensive. The companies also wrote in names of past employees in an effort to make it appear they were current employees and still being paid by the facilities.
