Two Pennsylvania nursing home operators were sentenced in federal court to pay more than $15 million in restitution for healthcare fraud involving false staffing certifications and obstructing federal investigations.
Comprehensive Healthcare Management Services, operator of Brighton Rehabilitation and Wellness Center, and the affiliated operator of Mount Lebanon Rehabilitation and Wellness Center were convicted of making false statements in connection with healthcare benefit payments and obstructing federal investigations. Prosecutors accused the companies of falsely certifying names of individuals who were not currently working in the buildings and not providing direct patient care. Supervisors manipulated staffing sheets to demonstrate minimum staffing ratios were met, allowing the companies to avoid penalties and receive federal funding from the Centers for Medicare & Medicaid Services. Despite being understaffed, the facilities continuously pushed for new patient admissions even when nurses claimed they could not properly care for additional residents.
Family members testified about the impact on residents, including one female resident who was seriously injured from a violent physical assault by a male resident when no nursing home staff were present to prevent the abuse or come to the victim's aid. Family members described significant staffing declines following acquisition by the defendant companies and detailed how decreased staffing levels negatively impacted their relatives' care, treatment, health, well-being, and hygiene.
"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 Troy 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."
FBI Pittsburgh Special Agent in Charge Kevin Rojek stated, "Families counted on these facilities and their operators to care for their loved ones with honesty, integrity, and compassion. Instead, these facilities put profits over people."
Judge Robert J. Colville described the defendants' actions as "a tragic set of events" that not only increased the risk of inadequate care for the facilities' patients but also impacted the lives of the facilities' employees and the general public.
This case shows vulnerabilities in nursing home oversight and Medicare/Medicaid funding systems. The manipulation of staffing records directly endangers patient safety while defrauding taxpayer-funded healthcare programs. With nursing homes already facing staffing shortages nationwide, this case shows how financial incentives can create situations where facilities prioritize admissions and funding over adequate patient care. The substantial restitution amount signals federal authorities are taking healthcare fraud in long-term care facilities seriously, particularly when it involves falsifying staffing levels that are designed to protect vulnerable elderly residents.
Healthcare facilities must maintain accurate staffing records and adequate patient care ratios are genuinely met, not just documented on paper. This case serves as a warning that federal authorities will pursue penalties when facilities manipulate staffing data to secure funding at the expense of patient safety.
Executives can face criminal charges, including prison time, fines, and exclusion from participating in federal healthcare programs.
CMS typically uses payroll-based journal (PBJ) data submitted by facilities, alongside audits and inspections, to monitor staffing compliance.
Federal law requires facilities receiving Medicare or Medicaid to provide “sufficient nursing staff” to meet residents' needs under 42 CFR § 483.35.
Yes, families may pursue civil lawsuits for negligence, wrongful death, or elder abuse in state court.
While difficult to quantify, staffing fraud is a recurring issue, especially in facilities facing financial pressure or rapid ownership changes.