Elder Justice Coordinating Council 

Remarks of Susan Carney Lynch, JD, DrPH, Senior Counsel for Elder Justice 

United States Department of Justice, Civil Division, Elder Justice Initiative 

June 21, 2022 

Good morning Chairwoman Barkoff and members of the Elder Justice 

Coordinating Council. I am Susan Lynch, Senior Counsel for Elder Justice at the 

United States Department of Justice, where for the past 23 years I have civilly 

prosecuted skilled nursing home chains, individual facilities, and owners and 

operators who provide grossly substandard care to their residents. I appreciate the 

opportunity to appear before you today to discuss the importance of nursing home 

enforcement and elder justice professional training at this critical time in our nation’s 

history when many of our nursing home residents are not receiving the quality care 

that they desperately need and are not being treated with the basic human dignity 

that we all deserve. As a result, some of our mothers, fathers, sisters, and brothers in 

this nation’s nursing homes are getting sicker, are being abused, neglected, and are 

even slipping into premature death. 

In my role leading the Department’s National Nursing Home Initiative, I have 

heard some tragic stories and have seen some gut-wrenching facts in the grossly 

substandard care cases that we investigate and prosecute. I want to be clear – we are 

not painting the nursing home industry with a broad brush and many nursing homes 

work hard to provide quality services to those entrusted to their care. But, I can tell 

you, members of the Council, that today, across this country, in urban, rural, and 

frontier communities, some nursing homes do not have adequate numbers of trained 

nursing staff to care for their residents, which includes enough staff to feed and turn 

and reposition vulnerable residents, do not have adequate nursing supplies to care 

for their residents, do not follow required infection control protocols in their 

facilities, do not keep their nursing homes clean and safe, and some nursing homes 

overuse antipsychotic medications in an effort to keep their residents compliant. 

Some of these same nursing homes continue to admit residents to their full census 

capacity despite knowing that they lack adequate staff and resources to care for these 

residents. With some of these poor-performing nursing homes, the nation watched 

in horror as the challenges of the COVID-19 pandemic quickly exacerbated poor 

quality of care conditions, with devastating consequences for our nation’s vulnerable 

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residents. There were also devastating consequences for some nursing staff as they 

worked tireless and heroically through the pandemic all the while navigating 

impossible working conditions brought on by staffing and census choices made by 

owners and operators. 

For over two decades, the Department of Justice has brought civil and criminal 

cases against the nation’s largest nursing home chains, small regional chains, single

facilities, and against nursing home CEOs and executives who provide grossly 

substandard care to their residents and commit criminal financial fraud. The 

Department has brought these entities and individuals to justice through its National 

Nursing Home Initiative, announced in March of 2020, and through the ongoing 

work of the Department’s Elder Justice Initiative. The Department’s Nursing Home 

Initiative coordinates and enhances civil and criminal efforts to pursue nursing 

homes that provide grossly substandard care to their residents and is focused on 

some of the worst nursing homes around the nation. The Initiative reflects the 

Department’s larger strategy and commitment to protecting our nation’s seniors 

through the work of multiple departmental components, including the Civil 

Division’s Elder Justice Initiative, the Consumer Protection Branch, the Criminal 

Division, and the Civil Rights Division in conjunction with the United States 

Attorney’s offices. 

We have done this important work with the help of and in partnership with 

many federal, state, local, tribal, and non-governmental partners who include the 

Department of Health and Human Service (”HHS), Centers for Medicare and 

Medicaid Services (“CMS”), some of the agencies at the Council table today, the 

Medicaid Fraud Control Units, state and local prosecutors’ offices, state Adult 

Protective Services agencies, state Long-Term Care Ombudsman programs, law 

enforcement, and emergency medical services nationwide, to name a few. 

Through its Initiatives, across the United States Attorneys’ offices, and with 

the help of its ninety-four Elder Justice Coordinators, the Department has dedicated 

prosecutors in every judicial district who are focused daily on protecting America’s 

elders in nursing homes. I will share with this Council a few cases which highlight 

the important nursing home enforcement work that we are doing across the nation. 

Just last week, the Department’s Elder Justice Initiative announced that it filed a

civil False Claims Act case against American Health Foundation (AHF), its 

affiliates, and three affiliated nursing homes in Ohio and Pennsylvania. In its 

complaint, the United States alleged that three AHF nursing homes provided grossly 

substandard services that failed to meet required standards of care, such as by failing 

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to maintain adequate staffing, failing to follow infection control protocols, and by 

providing their residents with unnecessary medications, including antibiotic, 

antipsychotic, anti-anxiety and hypnotic drugs. 

The United States’ complaint also provides specific allegations of how this 

grossly substandard care harmed AHF’s nursing home residents. For instance, the 

complaint alleged that one facility resident was admitted with a history of self-harm 

and was hospitalized after slashing his wrists while in the facility’s care. Yet when 

this resident returned to the facility, nursing home staff again ignored warning signs 

and failed to provide this gentleman with desperately needed psychiatric services. 

Mere weeks after being readmitted to this AHF facility, this resident committed 

suicide by hanging himself from a bedsheet in one of the facility’s shower rooms. 

Last May, the Department’s Elder Justice Initiative announced that it settled 

a civil False Claims Act case with Georgia-based SavaSeniorCare LLC and related 

entities for over 11.2 million based on allegations that Sava billed the Medicare 

program for rehabilitation therapy services that were not reasonable, necessary or 

skilled, and to resolve allegations that Sava billed the Medicare and Medicaid 

programs for grossly substandard skilled nursing services. This settlement resolved 

allegations that between 2008 and 2018, Sava knowingly submitted false claims for 

payment to Medicare and Medicaid for grossly substandard nursing services 

including, that Sava failed to have sufficient staffing in certain facilities, failed to 

follow appropriate pressure ulcer protocols, and failed to appropriately administer 

medications to some of the residents. 

Given the particularly egregious nature of the resident harm at issue in some 

of these types of cases, nursing home defendants frequently enter into Quality of 

Care Corporate Integrity Agreements (“CIAs”) with the HHS Office of Inspector 

General at the same time they settle their False Claims Act liability with the 

Department of Justice. For example, as part of the Sava settlement, Sava entered 

into a 5-year Quality of Care Corporate Integrity Agreement with HHS-OIG, where 

Sava is required to have a comprehensive compliance program with systems in place 

to address the quality of resident care including specific staffing provisions. 

In the most egregious cases, the Department has and will pursue criminal 

prosecutions of nursing home owners and operators who commit financial fraud 

and/or provide grossly substandard care to their residents. In January of this year, 

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the U.S. Attorney’s Office for the District of New Jersey and the Department’s Tax 

Division charged Joseph Schwartz with failing to collect, truthfully account for, and 

pay over $38 million in payroll taxes owed to the IRS on behalf of his employees as 

required by law. Schwartz owned and operated the New Jersey-based Skyline 

Management Group LLC and several related Skyline companies, which in turn 

owned and managed 95 health care and rehabilitation facilities operating in at least 

11 states. If convicted, Schwartz faces a maximum penalty of five years in prison for 

each count of willful failure to collect and pay employment taxes, five years in prison 

for each count of tax evasion, and ten years in prison for each count of failure to file 

a benefit plan report. 

And in February of this year, the United States Attorney’s Office for the 

Western District of Pennsylvania indicted Susan Gilbert, the former administrator of 

a Mount Lebanon skilled nursing home on charges of conspiracy to defraud the 

United States, health care fraud, and obstruction of a federal audit. According to the 

indictment, between 2018-2020, Gilbert and co-conspirators deprived seniors of 

needed resident care by using inflated nursing hours, falsifying timecards and other 

schemes that they concealed with two sets of records. According to the indictment, 

Gilbert and/or other co-conspirators directed administrative and management-level 

nursing staff and other employees to "clock in" for shifts but not actually work those 

shifts and paid bonuses to staff if they clocked in as instructed. This alleged conduct 

put facility residents at risk by only providing a dangerously low level of nursing 

staff just before COVID began to surge across the country – resulting in paper 

compliance that left residents without sufficient staff to care for their basic needs. 

The Department is committed not only to its work in nursing home 

enforcement but also to training elder justice professionals to prevent, identify, and 

report elder abuse in this nation’s nursing homes. Through its programmatic efforts, 

the Department has trained federal and state prosecutors, law enforcement, 

emergency medical service providers, and nursing home staff in an effort to identify 

the red flags for suspected elder abuse in nursing homes, how to document this 

abuse, and where and how to report thru the most appropriate and effective channels. 

In closing, the Department is actively engaged in bringing to justice those who 

provide grossly substandard care to our nation’s vulnerable nursing home residents 

and we remain committed to using all appropriate tools and pathways to investigate, 

prosecute, and prevent abuse of our nation’s elderly in nursing homes. We also 

remain committed to training elder justice professionals to prevent, identify, and 

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report elder abuse and neglect. As one government, we all have an obligation to 

ensure that the nation’s most vulnerable receive quality care and enjoy quality of life 

during their nursing home stays, which for many residents, is at the end of their lives 

when they are most dependent on others for their most basic care needs. Ensuring 

that nursing homes meet care quality regulatory and physical plant requirements falls 

within the mission of many of us at the Council table today. At the Department, we 

look forward to working with each of you on the Council and your agency designees 

in service of our collective mission to combat elder abuse in our nation’s nursing 

homes, at a time when the lessons of COVID-19, the urging of the Biden 

Administration, and the work of the National Academies are all pointing to the fact 

that our collective action is urgently needed. Now is the time to work together – we 

have the opportunity, and critically - we have the responsibility. 

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