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Former Administrator at Sister Facility of Brighton Rehabilitation and Wellness Center in Pennsylvania Indicted for Role in Fraud Conspiracy

A 60-year-old former administrator of a rehab and wellness center has been indicted for charges that include health care fraud, defrauding the United States and obstruction of a federal audit.

The investigation into Susan Gilbert, the former administrator at Mount Lebanon Rehabilitation and Wellness Center, is still ongoing. If convicted of all charges, she could face up to 10 years in prison as well as a fine of $250,000. Mount Lebanon is a sister nursing home to Brighton.

A joint investigation by the U.S. Attorney’s office as well as the Pennsylvania Attorney General’s led to the charges before a federal grand jury.

The allegations are that Gilbert directed various employees to falsify company records so it would look as if the facility met both state and federal staffing requirements.

The indictment alleges that between October 2018 and February 2020, Gilbert led a conspiracy that defrauded Pennsylvania of both property and money. She impaired, impeded, obstructed, interfered with and defeated the governmental functions of the U.S. Department of Health & Human Services in its administration of Medicaid, as well as the Pennsylvania Medicaid program.

She is also alleged to have obstructed the work of a federal auditor as well as committing health-care fraud.

Gilbert was the administration of Mount Lebanon, a skilled nursing home in Allegheny County, Pennsylvania. The facility is part of a larger company that owns various long-term care facilities in the state, which includes the Brighton Rehabilitation and Wellness Center.

According to the indictment, Gilbert and her co-conspirators directed nursing staff at the management and administrative level to “clock in” for shifts they didn’t actually work. This led to the company creating falsified timecards, making it appear the individuals were providing direct care to residents when they weren’t even in the building.

Those involved include general administrative staff, the assistant director of nursing, and the director of nursing. The staff was coerced into conspiring with Gilbert because they were given monetary bonuses for doing so.

In addition to clocking in for hours they didn’t work, the staff was also instructed not to clock out for lunch breaks, which were 30 minutes. They then falsified timecard sheets that were provided to the Department of Health & Human Services.

Gilbert instructed administrative staff to maintain two books that reflected levels of staffing — one that was accurate with the actual hours worked and one with the falsified information. The falsified book was provided to investigators at the DOH when they conducted inspections that were mandated by federal law.

Gilbert is alleged to have done this with her co-conspirators so the facility would look as if it complied with all conditions for participating in the Pennsylvania and federal Medicaid programs.

One condition is the facility must have “sufficient” nursing staff on hand to meet the needs of residents. Another is the facility was able to operate and provide services that complied with all state, local and federal codes, laws and regulations.