Comprehensive Healthcare falsified records to earn higher federal reimbursements, witnesses say

Social worker Jamie Folkens had worked at a nursing care facility in Mt. Lebanon for seven years before Comprehensive Healthcare bought it in early 2017.

Although she felt her job was to help patients return home as quickly and safely as possible, she told a jury Tuesday in federal court that Comprehensive’s new regional director of social services, Johnna Haller, wanted them to stay longer.

“The longer somebody stayed, the better it was for the building and the company,” Folkens said.

She was serving as director of social services at Mt. Lebanon Rehabilitation and Wellness when, in the spring of 2017, Folkens took two months of family medical leave.

When she returned, she testified, Folkens found that Haller, who never had interaction with patients and was only on-site once a month, had been changing patient depression scores to get an increased reimbursement from the Centers for Medicare and Medicaid Services.

The notes for the evaluation were word-for-word what they had been when staff did the depression assessment, but the numbers were significantly increased, she said.

“It didn’t make any sense,” Folkens said.

She immediately began looking for a new job, knowing she would report what was happening to the federal agency.

“I knew things were not being done ethically,” Folkens said.

Folkens, who now works in hospice care, was the fourth witness called by prosecutors in the trial against Haller and four other Comprehensive employees, as well as two of the nursing homes they operate.

They are on trial in federal court in Downtown Pittsburgh on charges of health care fraud and conspiracy.

The government said they engaged in two separate schemes to earn increased reimbursements from the Centers for Medicare and Medicaid Services and to falsify documents submitted to the state to show that they were meeting mandated staffing ratios even when they were not.

The trial, which began Nov. 16 before U.S. District Judge Robert J. Colville, is expected to last about five weeks. The defendants include Haller, Comprehensive owner and CEO Sam Halper; Brighton Rehab Director of Nursing Eva Hamilton of Beaver; Michelle Romeo of Hillsville, Lawrence County, who was a regional manager with oversight over nurses at the two facilities; and former Mt. Lebanon Rehab administrator Susan Gilbert of Cecil.

Brighton Rehabilitation and Wellness Center in Beaver County and Mt. Lebanon Rehabilitation and Wellness Center are also named defendants.

Defense attorneys told the jury in opening statements that government investigators had made a mistake, and no crimes had been committed by their clients, just sloppy record-keeping. They suggested it was a regulatory issue.

Folkens, who will return to the witness stand Tuesday on cross-examination, told the jury that when she returned from leave in July 2017, she began reviewing patient records to see what she had missed.

In doing so, she said she came across at least seven patients whose depression assessment scores had been recorded one way by staff, and about a week later, changed to be much higher by Haller.

“There would be no reason to reopen it and change the score,” Folkens said.

For one patient, their score went from a 3 to an 11. For another, she said, the change went from a 1 to 11. For another, it went from a 5 to a 12.

A score of 10 or higher triggers the increased reimbursement.

Folkens said she emailed Haller to ask why the scores had been changed. Haller called her, Folkens recalled, and said there was nothing that they did wrong.

“She just made some corrections and tweaks,” Haller told her.

Folkens said she knew it was wrong.

“The change was made to reflect a higher level of depression for a patient to yield a higher reimbursement,” she said.

Folkens quit her job at Mt. Lebanon Rehab in September 2017 and made an anonymous complaint to the Centers for Medicare and Medicaid Services.

“I didn’t want my name associated with it out of fear of retaliation,” she said. “I felt that it was fraudulent, and they needed to be made aware of it.”

The bulk of testimony from Monday and Tuesday revolved around the staffing ratio at Brighton Rehab. Under Pennsylvania law, nursing home facilities at that time were required to have 2.7 hours of direct patient care per resident per day, testified Susan Williamson, director of nursing care facilities under the state Department of Health.

If a facility fell below that number, Williamson said, they would be considered to be deficient and could be cited. Violations could result in being cited, being placed on a provisional license, being ordered to stop taking new admissions or being shut down.

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

If a facility is found to be deficient, they must submit a plan of correction that is reviewed periodically by the state.

Williamson’s department performs an annual survey at every facility in the state — about 650 — and also conducts reviews based on complaints and rechecks. The federal Centers for Medicare and Medicaid Services use those state reviews to ensure compliance.

She told the jury that several times in 2018 and 2019, Brighton and Mt. Lebanon were cited for failing to meet staffing requirements. Each time, they submitted a plan to address the concern, including having the director of nursing review staffing regularly.

“We expect you don’t just try, but you actually do it,” she said.

Staff members at the facilities were accused of punching in as if they were at work but then leaving for the day. The government referred to them as “ghost employees.”

“If they aren’t in the building, they wouldn’t be able to provide direct care to a resident,” Williamson said. “If they’re not willing to provide truthful information to us, doing our job is nearly impossible.”

On cross-examination, Williamson admitted that it is often hard for facilities to find reliable staff, and that they must contend with people calling off for holidays and events such as the Super Bowl.

But, she said, facilities need to plan for those contingencies and schedule more people on days where high call-offs are likely.

“They’re never permitted to lie,” she said.

Williamson told the jury on Tuesday that Brighton Rehab was identified as a special-focus facility candidate in July 2019. It’s a federal program for poor nursing home performers that provides additional monitoring and recertification every six months instead of annually.

Also testifying Tuesday was Ashley Ifft, who worked in human resources at Brighton Rehab from 2018 to November 2019.

Ifft told the jury it was not uncommon for employees to leave in the middle of their shifts.

She testified that Brighton Rehab had five biometric time clocks, which frequently malfunctioned. During her testimony, Ifft mentioned that the time clocks had been purchased off of eBay, prompting one defense attorney to ask if she’d been told by the government to say that.

She said she was not.

Ifft said she left Brighton Rehab in November 2019 after the administration there pushed to increase the patient population from the mid-to-upper 400s to 501.

“We didn’t have the staff to handle the (existing) patients, let alone additional ones,” she said. “It wasn’t a place I wanted to be.

“I did not feel the facility and the way it functioned ethically aligned with my values.”