Former Mt. Lebanon nursing home administrator indicted on health care fraud charges

As part of an ongoing state and federal investigation into the activities at long-term care facilities owned by Comprehensive Healthcare Management Services LLC, the former administrator at its Mt. Lebanon skilled nursing home was indicted Wednesday by a federal grand jury.

Susan Gilbert, 60, of Lawrence, is the only defendant. She is charged with conspiracy, health care fraud and obstruction of a federal audit.

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

Gilbert directed staff members to keep two separate sets of books — one that showed the actual, inadequate staffing levels at Mt. Lebanon Rehabilitation and Wellness Center, and one that was used to show inflated numbers to meet requirements of the federal government, according to the indictment.

Gilbert worked as the administrator at the Mt. Lebanon facility — which is part of the group of long-term care homes that includes Brighton Rehabilitation and Wellness Center in Beaver County. Those homes are currently under investigation for its handling of the covid-19 pandemic, officials said.

The privately owned Beaver County nursing home is the site of one of the nation’s deadliest covid-19 outbreaks and continues to confront legal challenges on multiple fronts. At least 76 Brighton Rehab residents and a housekeeper died of covid-19, and more than 300 staff and residents have been infected since late March, state records show.

Earlier this month, the Tribune-Review learned that the federal grand jury was investigating Brighton and its ownership group.

Gilbert conspired with others from Oct. 10, 2018, to Feb 20, 2020, according to the indictment.

Prosecutors allege that Gilbert and others who are unnamed in the filing directed employees of the Mt. Lebanon facility to falsify records to make it appear it met federal and state staffing requirements.

Under Pennsylvania regulations, nursing homes must provide at least 2.7 hours of direct resident nursing care, per resident, per day, the indictment said.

Part of the conspiracy, according to the indictment, was “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 identifies nine instances where Gilbert and other co-conspirators submitted falsified records to the Department of Health.

Among the allegations, the indictment said that Gilbert and others directed administrators, management-level nursing staff and other employees to clock in for shifts that weren’t worked to make it appear they were providing direct resident care even though they weren’t in the building.

To accomplish that, the indictment said that Gilbert and others paid monetary bonuses to those employees who were clocking in but not working.

Those employees were also told not to clock in or out during lunch breaks to make it appear they were providing care when they were not, prosecutors said.

The indictment alleges that Gilbert directed staff to include hours worked by administrative and management level staff on three-week staffing sheets given to the state Department of Health even though the hours hadn’t been worked.

Gilbert also is accused of directing administrative staff to keep two sets of books reflecting staffing levels, the indictment said. One book had accurate information that reflected the actual hours worked, and the other had falsified information to show an inflated level of staffing.

The falsified information was then provided by staff to Department of Health investigators during federal inspections, the indictment said.

“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,” said Pennsylvania Attorney General Josh Shapiro. “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.”

Comprehensive Health Care Services is also the defendant in a wide-ranging lawsuit filed by former residents and family members, accusing the leadership team of not only a “reckless” handling of covid-19 but also mismanagement, negligence and other issues that predated the pandemic, such as understaffing and infection control problems.

“The fact that there is a detailed indictment discussing multiple sets of books, false time keeping, false reporting to government agencies, all resulting in insufficient staffing provided to those most vulnerable is stunning,” said Bob Daley, one of the plaintiffs’ attorneys. “Again, we’ll have to wait and see what proves out, but the level of detail in the indictment is impressive and very concerning.”

Staff writer Natasha Lindstrom contributed to this report.