Sloppy Record-keeping?

A jury found two Western Pennsylvania nursing homes guilty for extensive federal charges related to Medicaid and Medicare fraud.

Pennsylvania’s attorney general last year indicted Sam Halper, co-owner of Brighton Rehabilitation and Wellness and Mt. Lebanon Rehabilitation and Wellness, on multiple counts. Authorities allege he masterminded a scheme in which staff intentionally inflated worker hours and falsified patient records in an effort to boost revenues and limit costs. 

At Mt. Lebanon, the scheme allegedly included having employees clock-in and be paid for shifts they did not work; keeping two sets of books reflecting staffing levels, with one containing accurate information and the other falsified records; and falsifying staffing documents for federally mandated inspections.

Defense attorneys argued the case involved “sloppy record keeping” rather than intentional fraud, TribLive reported.

However, evidence proved Halper directed managers to maintain unsafe staffing levels to reduce costs, even though caregivers knew that it caused neglect, burn-out, and abuse for residents.

Both facilities are managed by Comprehensive Healthcare Management Services, an entity affiliated with Ephram “Mordy” Lahasky. He has a 10% direct ownership stake in Brighton, while Halper has a 12% ownership stake. He faces a civil lawsuit along with Halpert in New York, where the attorney general has alleged the owners of The Villages of Orleans Health and Rehabilitation Center, misused more than $18.6 million in government funds for personal gain.

The surveyor’s testimony took the spotlight at the criminal fraud trial. Susan Williamson, director of nursing care facilities for the Pennsylvania Department of Health, outlined an alleged pattern of cost-cutting by evading state staffing regulations at both nursing homes. Both facilities repeatedly failed to meet the state’s staffing requirements, according to Williamson. They were cited multiple times in 2018 and 2019.

“Staffing is really the backbone of taking care of residents,” Wiliamson said. “Without being honest about staffing, your residents aren’t going to get the care they require.”

Pennsylvania nursing homes were only required to provide 2.7 hours of care per resident, per day at the time of the infractions. Consistent failure to meet this state threshold can result in facilities being placed on a provisional license or even being shut down. Pennsylvania’s 2.7 hours requirement is set to increase to 3.2 by July of 2024. Meanwhile, a proposed Centers for Medicare & Medicaid Services staffing mandate would increase the requirement to 3.0 nationally.

The government’s key assertion is that the facilities had recorded “ghost employees” clocking in to work and then leaving the facility without their absence being noted. This would have inflated the facilities’ hours per resident per day without actually providing that care. Ashley Ifft, former human resources employee at Brighton Rehabilitation, testified it was common for employees to leave work in the middle of the day. 20 former nursing home employees testified against the nursing home.

The jury’s guilty finding came after five weeks of testimony. Brighton Rehab was found guilty of healthcare fraud and five counts of falsification of records in a federal investigation, while Mt. Lebanon was found guilty of one count of falsification of records related to healthcare matters and three counts of falsification of records in a federal investigation.