A Lawrence County woman is among five people and two for-profit skilled nursing facilities in western Pennsylvania indicted by a Pittsburgh federal grand jury accused of conspiracy and related health care fraud charges.
U.S. Attorney for the Western District Cindy K. Chung and state Attorney General Josh Shapiro jointly announced in a news release Tuesday the 15-count superseding indictment was returned Aug. 5, naming Michelle Romeo, 46, of Hillsville, as one of the defendants.
Others named in the criminal charges are Sam Halper, 39, of Miami Beach, Florida; Eva Hamilton, 35, of Beaver; Susan Gilbert, 61, of Lawrence, Pennsylvania; and Johnna Haller, 41, of Monaca, as co-defendants.
The two nursing facilities named in the action are Comprehensive Healthcare Management Services, LLC, doing business as Brighton Rehabilitation and Wellness Center and Mt. Lebanon Operations, LLC, doing business as Mt. Lebanon Rehabilitation and Wellness Center.
The indictment alleges that Halper, the CEO and part-owner of the two indicted skilled nursing facilities, among others, conspired with others to defraud the United States and commit health care fraud. The investigation revealed two schemes — first, that management-level employees at the two nursing facilities, knowingly provided, or directed others to provide, falsified staffing records to the Pennsylvania Department of Health (DOH) during federally mandated surveys; and the facilities, under the direction of Halper and two other regional directors, Romeo and Haller, made false statements in resident assessments, also called Minimum Data Set (MDS) assessments, provided to the government to increase Medicare and Medicaid reimbursements.
Count One of the indictment charges Halper and former Director of Nursing, Eva Hamilton, with conspiring to defraud the United States from in and around June 2018, to in and around January 2020, by obstructing and interfering with the lawful governmental functions of the Centers for Medicare and Medicaid Services (CMS). The indictment alleges that Halper and Hamilton and other co-conspirators conspired to interfere with and obstruct the state health department in its ability to conduct valid federally mandated surveys of the care provided to residents at Brighton by knowingly falsifying staffing sheets provided to DOH in order to show that the facilities were in compliance with the conditions of participation in Medicare and PA Medicaid.
Among other acts, Halper and Hamilton and other co-conspirators added the names of nursing staff who were not in the building on the dates listed on records provided to DOH, to make it appear as though these nurses were working and providing direct care to residents. The co-defendants allegedly engaged in these acts in whole or in part, to avoid government sanctions, including a denial of payments for new admissions, additional monitoring, the imposition of civil monetary penalties, and other potential penalties.
Count Two of the superseding indictment charges these same individuals as well as Brighton, with, between on or about July 18, 2018, to on or about Jan. 22, 2020, falsifying, concealing or covering up by trick, scheme or device material facts in connection with the delivery of or payment for health care benefits; that is, the co-defendants engaged in a scheme to provide falsified staffing sheets to DOH in order to show that Brighton was in compliance with the conditions of participation in Medicare and Medicaid, including that the facility had “sufficient” nursing staff to meet residents’ needs and that the facilities were operating and providing services in compliance with all applicable federal, state, and local laws, regulations, and codes. Counts Three through Seven of the Superseding Indictment charges Hamilton and Brighton with making false statements in staffing records with the intent to impede, obstruct, and influence the investigation and proper administration of a matter within the jurisdiction of CMS, an agency of the United States.
Count Eight of the Superseding Indictment charges Gilbert, the former administrator of Mt. Lebanon Rehabilitation and Wellness Center and the current administrator of another facility owned by Halper, with, from on or about Oct. 10, 2018, to in and around March 2020, conspiring to defraud the United States by interfering with and obstructing DOH in its ability to conduct valid federally mandated surveys of the care provided to residents at Mt. Lebanon.
Among other acts, the Superseding Indictment alleges that Gilbert and/or other co-conspirators directed administrative and management-level nursing staff and other employees to “clock-in” for shifts not actually worked. In doing so, Mt. Lebanon Rehabilitation and Wellness Center created falsified timecard documentation provided to DOH that made it appear as though these individuals were providing direct resident care, when in fact they were not in the building and therefore not providing direct resident care.
Count Nine charges Gilbert and Mt. Lebanon, with, on or about Nov. 13, 2019, and continuing to on or about February 20, 2020, participating in a scheme to falsify, conceal or cover up by trick, scheme or device material facts in connection with the delivery of or payment for health care benefits; that is, the co-defendants engaged in a scheme to provide falsified staffing sheets to DOH in order to show that Mt. Lebanon had “sufficient” nursing staff to meet residents’ needs and that the facilities were operating and providing services in compliance with all applicable Federal, State, and local laws, regulations, and codes.
Counts 10 through 12 charge Gilbert and Mt. Lebanon with making false statements with the intent to impede, obstruct, and influence the investigation and proper administration of a matter within the jurisdiction of CMS.
Count 13 charges Gilbert further with, in or around March 2020, participating in a scheme to falsify staffing records at another nursing facility in order to show that this facility was in compliance with the conditions of participation in Medicare and Medicaid.
In addition, Count 14 alleges that from in and around June 2014 to in and around June 2021, Halper conspired with two regional-level employees, Romeo and Haller, and others to commit healthcare fraud. Among other acts, the indictment alleges Romeo instructed nursing staff who completed MDS assessments at the various facilities she supervised to make changes to residents’ assessments to ensure that those facilities had certain Case Mix Index (CMI) score associated with higher reimbursements. Romeo and other co-conspirators also instructed staff at the facilities to create false documentation in residents’ MDS assessments to justify changing a resident’s Activities of Daily Living (ADL) score — which is intended to reflect a resident’s needs for assistance with daily living activities such as bed mobility, toilet use, and eating – by writing a note stating that the changes were made after “interviewing” nursing staff when in fact no such interviews were conducted.
Halper, Romeo and Haller and/or other co-conspirators also conspired to input inaccurate responses to certain resident questionnaires in order to falsely inflate residents’ depression scores. The superseding indictment alleges Halper, Romeo and Haller directed these changes in the MDS data to increase reimbursements and not to accurately capture residents’ medical conditions or needs.
Count 15 of the indictment charges Romeo and Haller, from in and around December 2016 to in and around June 2021, with health care fraud related to their involvement in the submission of false information in the MDS assessments to receive higher reimbursements from Medicare and Medicaid.
“Our office will continue to hold individuals and facilities that break the law accountable,” Chung said. “Health care fraud is not a victimless crime. It affects everyone—individuals and businesses alike—and causes 10s of billions of dollars in losses each year.”
“Through our joint investigation with the U.S. Attorney’s Office for the Western District of Pennsylvania and the Federal Bureau of Investigation, we found that Brighton and Mt. Lebanon’s senior administrators used two criminal schemes to take advantage of federal programs and make extra money while putting residents at risk,” Shapiro said. “These charges today represent a dereliction of duty to report accurate information, criminal schemes designed to manipulate the system, and above all else, companies and individuals that put profits above truthful reporting. I am proud to stand with our federal partners and in unison say, we will not stand by while companies or those who run them break our laws and put people’s safety at risk.”
As to counts one, two, eight, nine and 13, the law provides for a maximum total sentence of not more than five years in prison, a fine of $250,000 or both. Counts three through seven, and 10 through 12 each carry a maximum possible sentence of 20 years in prison, a fine of $250,000 or both. Finally, Counts 14 and 15 each carry a maximum possible sentence of 10 years in prison, a fine of $250,000 or both. Under the federal sentencing guidelines, the actual sentence imposed would be based upon the seriousness of the offenses and the prior criminal history, if any, of the defendants.
The Federal Bureau of Investigation, the U.S. Department of Health & Human Services – Office of Inspector General, the Pennsylvania Office of Attorney General, and the Internal Revenue Service – Criminal Investigation conducted the investigation leading to the indictment.
An indictment is an accusation. A defendant is presumed innocent unless and until proven guilty.