From almost the day it took over Brighton Rehabilitation and Wellness Center in Beaver County in 2014, Comprehensive Healthcare Management Services began submitting fraudulent records to state and federal authorities in a quest to drive up revenue at the nursing home, according to a federal criminal grand jury indictment unsealed Tuesday.
But illegally increasing the flow of money was just the beginning, according to the indictment announced by U.S. Attorney Cindy K. Chung along with Pennsylvania Attorney General Josh Shapiro, whose offices worked together on the case.
A couple of years after Comprehensive bought Brighton and another nursing home in 2017 in Mt. Lebanon, its employees also allegedly began falsifying records to make it appear that they both provided adequate care each day to their fragile elderly residents in a quest to also drive down costs.
A Post-Gazette investigative series in 2020, Brighton’s Plight, about the deadly COVID-19 outbreak at the facility — one of the worst in the nation — showed that the alleged scheme was lucrative for Brighton’s private owners. Millions of dollars of profits, rents and management fees poured into Comprehensive’s coffers, starting just a year after Beaver County — which regularly lost money on the facility — sold it to the for-profit owners.
As a result, one of their co-owners, Sam Halper, 39, who was charged in the case, reaped “millions” from their operations from 2017 to 2020, according to the indictment.
Both facilities were charged in the indictments unsealed Tuesday: Comprehensive Healthcare Managing Services — operator of Brighton — and Mt. Lebanon Operations, the LLC behind Mt. Lebanon Rehabilitation and Wellness Center, though they share upper management, including Mr. Halper. Both facilities were raided by the FBI in September 2020 and had boxes of records removed.
Tuesday’s 15-count indictment includes allegations of Medicare and Medicaid health care fraud, conspiracy to commit health care fraud and other charges.
Named in the indictment are Mr. Halper, CEO of the two indicted facilities; Eva Hamilton, 35, the director of nursing at Brighton Rehabilitation from 2014 to 2020; Susan Gilbert, 61, the administrator at Mt. Lebanon Rehabilitation from 2017 to 2020; and Michelle Romeo, 46, and Johnna Haller, 41, both regional managers for the facilities.
Mr. Halper was arrested at his Pittsburgh home Tuesday morning and arraigned before a federal magistrate in the afternoon. His bond was set at $100,000, he had to surrender his passport as well as any firearms, halt contact with any other defendants, and was instructed to only travel between his home areas of Pittsburgh and Miami Beach.
Ms. Gilbert is expected to be arraigned Thursday, and the other three defendants will have their initial appearances and arraignments then, too.
“Health care fraud, particularly fraud that impacts elderly patients, is not a victimless crime,” Ms. Chung said at a news conference Tuesday. “It affects everyone, individuals and businesses alike, and causes tens of billions of dollars in losses each year.”
Mr. Shapiro said the alleged schemes allowed the facilities to make extra money off of federal programs while putting residents at risk.
“When we entrust institutions … with the care of the elderly, we expect there will be a basic level of qualified professionals on the job to look after the people that we love,” he said.
The investigation that led to the indictments began in May 2020 with allegations of neglect during the raging COVID-19 outbreak there, according to anonymous Attorney General Office officials who spoke on background.
“As we investigated [the neglect allegations], one thing led to another,” one of those officials said.
Tuesday’s announcement did not involve any allegations of neglect, but that investigation continues, Mr. Shapiro said.
In the indictment, Ms. Hamilton and Mr. Halper are alleged to have conspired from June 2018 to January 2020 to falsify records to make it appear that there were more “direct care” work hours provided to residents at Brighton than were actually being provided.
To ensure that they had at least the 2.7 hours per day, per resident staffing levels required by the state, they allegedly added the hours worked by management and other administrators to the “direct care” hours, even though they did not work with residents; added hours nursing staff were on their lunch breaks; and logged in hours worked by employees who were not even present in the building.
This began because Mr. Halper “directed management staff at Brighton to keep staffing levels low to reduce costs,” the indictment alleges.
The indictment also says that another person, listed as “co-conspirator A,” helped in this scheme, which likely indicates that this person is cooperating with prosecutors.
A similar scheme was orchestrated at Mt. Lebanon by Ms. Gilbert, who was previously indicted in the case in February 2021 and pleaded not guilty to the charges.
She is accused of not just asking management nursing staff to clock in for shifts from October 2018 to March 2020 that they did not actually work, but she paid them bonuses for doing so, the indictment alleges.
The defendants committed the alleged fraud in order to evade government sanctions, such as a denial of payments for new admissions, monetary penalties and the termination of access to Medicare and PA Medicaid, the indictment says.
The broader conspiracy charges involving both facilities were even more complex, beginning in June 2014, just a few months after Brighton was purchased, and continuing to June 2021.
In that conspiracy, Mr. Halper, Ms. Romeo and Ms. Haller allegedly worked together to tweak various data points — relating to eating, mobility, health and mood — for each resident in the facilities so that the facilities were paid more money through Medicare and Medicaid.
For example, data points regarding whether a resident was depressed or not were supposedly altered, since having more residents listed as depressed contributed to being paid more by the government.
Mr. Halper is alleged to have told someone — who is “known” to the grand jury — to designate residents as depressed “without regard to whether the residents in fact suffered from depression.”
Ms. Haller, Ms. Romeo and others then allegedly put “false and fabricated responses” into residents’ questionnaires to inflate their depression “scores,” which would help the facilities be paid even more.
Robert Daley, an attorney representing the families of residents who died or lived at Brighton during the COVID-19 outbreak in several civil lawsuits, said he was happy to see that the allegations made in the federal criminal indictment “mirrors what we’ve been saying all along in our civil cases: That Brighton not only systematically understaffed, but falsified staffing, and then, beyond that, increased acuity levels and exaggerated how sick its residents were so they could get higher additional, increased reimbursements.”
Though the allegations in the federal criminal indictment don’t directly allege any impact on what happened during the COVID-19 outbreak, Mr. Daley points out the allegations of understaffing in the years before the outbreak “means when COVID hit they were systemically understaffed.”
Jodi Gill, whose father was a resident at Brighton and now lives in a different nursing home, said it was clear to her that “they chronically understaffed, and that’s what led to the situation before COVID and after.”
She has been one of the most vocal critics of Brighton over the last two-plus years and filed some of the early complaints against the facility in 2020 in a quest to keep her father safe.
After she heard an indictment was coming down Tuesday, when she visited her father at his nursing home, she said she told him that “we were vindicated” finally.
Sean D. Hamill: shamill@post-gazette.com; 412-263-2579; Twitter @SeanDHamill.; Mick Stinelli: mstinelli@post-gazette.com.
First Published: August 9, 2022, 5:08 p.m.
Updated: August 9, 2022, 9:15 p.m.
