Senior Care Policy Brief: The Business of Broken Care

Widespread fraud and chronic accountability failures continue to plague the U.S. nursing home system, allowing operators to siphon funds while vulnerable residents suffer the consequences. Two recent federal actions – involving Joseph Schwartz, whose Skyline empire collapsed under the weight of a massive tax fraud scheme, and Benjamin Landa, whose Pinnacle Multicare facility was found to have improperly billed tens of millions of dollars in Medicare payments – underscore just how deeply financial exploitation is embedded in the long-term care industry.

These cases expose a system in which owners can engage in large-scale misconduct for years because weak oversight provides minimal deterrence for predatory operators.

• Schwartz’s Skyline network at its peak operated over 100 nursing homes across 11 states.
• In 2018, Skyline imploded, and Schwartz essentially abandoned his nursing homes. States had to step in to provide food and medication for residents and pay for staff.
• The collapse of Skyline put an estimated 7,000 residents and 15,000 workers at risk, forced multiple states to step in with emergency conservators, and became a national example of how opaque ownership and weak oversight can destabilize nursing homes.
• In April 2025, he pleaded guilty to an employment tax fraud scheme involving nearly $38 million.
  • Exploitation Excused: In November 2025, President Trump issued a full and unconditional presidential pardon that eliminated Schwartz’s sentence, fine, and restitution obligations.

• A recent federal audit of Pinnacle Multicare Nursing and Rehabilitation Center, associated with long-time operator Benjamin Landa, revealed extensive improper billing.
• Why OIG audited Pinnacle: Medicare changed how it pays nursing homes in 2019, adopting the Patient Driven Payment Model (PDPM). Under PDPM, facilities are paid based on patients’ conditions and needs, rather than volume of therapy. OIG flagged Pinnacle because billing data showed a large jump in Medicare Part A payments after PDPM started, suggesting possible overbilling.
• What OIG found: Pinnacle’s Medicare billing was almost entirely improper: 99 out of 100 skilled nursing claims reviewed did not meet Medicare payment rules.
• Those errors led to about $1.1 million in overpayments just in the 100-claim sample. Based on the sample, OIG estimated Pinnacle was overpaid by at least $31.2 million.
• Landa has a long history of troubling nursing home operations. See, for example, How N.Y.’s Biggest For-Profit Nursing Home Group Flourishes Despite a Record of Patient Harm.
• Wrongdoing Rewarded?: In October 2025, President Trump nominated Benjamin Landa to be the U.S. Ambassador to Hungary.