Enforcement · April 1, 2026 · 14 min
Where Skyline’s 56 Nursing Homes Went
By Robert Benard, MS, RN, CNS, AGACNP-BC, PMHNP-BC
Joseph Schwartz was convicted, pardoned, and barred from CMS ownership. But all 56 of his nursing homes are still operating — under 11 different successor chains, with $1.33 million in current penalties, $46.4 million in related-party costs, and 25 facilities reporting antipsychotic prescribing rates above 20%. Here is where each one went, with links to every facility page.
What this post covers
This is the second in a four-part series on the federal healthcare fraud enforcement surge of 2026. The first post laid out the timeline — the CRUSH RFI, the Task Force to Eliminate Fraud, Operation Never Say Die, and the pardons of convicted nursing home operators.
This post follows the data on one of those operators. Joseph Schwartz founded Skyline Healthcare and operated as many as 100 nursing homes across 11 states before the chain collapsed in 2018–2019. He was convicted of $38 million in federal tax fraud and pardoned by President Trump in November 2025 after serving three months. (ProPublica, March 30, 2026)
The question this post answers is not about Schwartz himself — he no longer appears in any current CMS ownership record. The question is: what happened to the facilities? Where did 56 nursing homes go after the chain collapsed, and what do the enforcement numbers look like at those facilities today?
The answer comes from CMS Change of Ownership (CHOW) records, current ownership files, and facility-level enforcement data across all 14,713 Medicare-certified skilled nursing facilities on OversightReports.com. Every facility mentioned below links to its full data profile.
The Skyline collapse: what the federal records show
CMS Change of Ownership records list Joseph Schwartz across 56 unique facility enrollment IDs spanning 9 states — Arkansas, Florida, Kansas, Kentucky, Maryland, Nebraska, New Jersey, Pennsylvania, and South Dakota. Schwartz appeared as CEO and member of Skyline Services Group LLC and Skyline SD Management LLC, both registered at 505 Marlboro Road, Wood-Ridge, New Jersey. His wife Rosie Schwartz appears on 42 of the same enrollment IDs, confirming co-ownership. (NBC News, 2019)
All 56 facilities were transferred to new operators between 2018 and 2019 as the chain collapsed. Staff in multiple states went unpaid. In South Dakota, a Skyline vice president emailed the state that "there is no money." A wrongful death lawsuit in Arkansas resulted in a $15.7 million judgment against the Schwartz family. Kansas passed new legislation requiring greater financial disclosure from nursing home buyers directly because of Skyline. (KELOLAND, 2022)
Every one of the 56 facilities is still operating today under new ownership.
Where the 56 facilities landed: the successor chains
CMS ownership records show that Skyline's 56 facilities were absorbed by at least 11 different successor operators. The largest concentrations went to:
- Mission Health Communities — 15 facilities in Kansas, operated by Coronado Operator LLC, Barres LLC, and Curis Holdings LLC
- Legacy Healthcare / Avantara — 11 facilities in South Dakota, operated by Doros Generation Trust, GPN Family Trust, and Oakway Operations
- LME Family Holdings — 9 facilities in Pennsylvania, operated by Underscore Holdings, BLES Healthcare Management, and Harborview Holdings
- Aston Health — 5 facilities in Florida, operated through a network of holding companies linked to Leopold Friedman
- Emerald Healthcare — 4 facilities in Nebraska, operated by Columbus/Cozad Operations and JW Nebraska Operations
- Paramount Care Centers — 3 facilities in New Jersey
- Lyon Healthcare — 3 facilities in Kentucky, operated by A&M Healthcare Investments
- Prestige Care Center — 2 facilities in Nebraska
- Marsh Pointe Management — 2 facilities in Arkansas, operated through the Brogdon Grandchildren Trust
- Arbor Care Centers — 1 facility in Nebraska, operated by the Klaasmeyer family
The operators changed. The facilities did not close. The residents kept aging in them.
What the enforcement data shows today
Across all 57 Schwartz-linked facilities (56 from Joseph's CHOW records, plus one facility where his son Louis holds a current 10% ownership stake):
- Average CMS star rating: 2.51 out of 5
- Total CMS civil money penalties: $1,326,004 (across current penalty records)
- Total related-party transaction costs: $46.4 million (HCRIS Worksheet A-8)
- Average zero-bedside-RN days: 4.75%
- High-risk facilities (composite risk score ≥ 60): 4
These numbers belong to the current operators, not to Schwartz. CMS penalties are assessed against whoever holds the provider agreement at the time of the violation. The point is not to attribute today's conditions to a previous owner. The point is that these facilities — the same buildings, the same beds, many of the same residents — passed through a chain collapse and continue operating, and the enforcement record is visible for each one.
The highest-risk former Skyline facilities
Four former Skyline facilities currently score above 60 on the OversightReports composite risk index (a 0–100 scale incorporating deficiency severity, penalties, staffing, ownership patterns, and quality measures). All four hold 1-star CMS ratings.
1. Wyndmoor Hills Rehabilitation and Nursing Center — CCN 396115, Pennsylvania
Composite risk: 65.1. CMS stars: 1/5. Total penalties: $102,309. Zero-RN days: 2.2%. Related-party costs: $835,821 (FY2024). Now operated under LME Family Holdings. Joseph Schwartz previously held 100% direct ownership through Wyndmoor Care Center LLC.
2. Emerald Nursing & Rehab Omaha — CCN 285097, Nebraska
Composite risk: 64.8. CMS stars: 1/5. Total penalties: $169,318. Zero-RN days: 6.5%. Related-party costs: $516,875. Antipsychotic prescribing rate: 26.4% — well above the national average of 16.98% under CMS's updated measure. (The OIG confirmed in March 2026 that some facilities use schizophrenia diagnoses to mask antipsychotic prescribing.)
3. Monument Rehabilitation and Care Center — CCN 285095, Nebraska
Composite risk: 62.0. CMS stars: 1/5. Total penalties: $68,398. Zero-RN days: 9.8%. Related-party costs: $837,307. Antipsychotic prescribing rate: 27.5%. Also under LME Family Holdings.
4. Avantara Arrowhead — CCN 435051, South Dakota
Composite risk: 60.9. CMS stars: 1/5. Total penalties: $47,981. Related-party costs: $287,817. Antipsychotic prescribing rate: 35.8%. Now operated under Legacy Healthcare / Avantara.
Antipsychotic prescribing across former Skyline facilities
Of the 57 Schwartz-linked facilities, 25 report antipsychotic prescribing rates above 20% — well above either the old national average (14.64%) or the updated measure incorporating claims data (16.98%). The OIG's March 2026 reports documented that some nursing homes inappropriately diagnose residents with schizophrenia to mask antipsychotic use and inflate their star ratings.
Three former Skyline facilities stand out:
- Edwardsville Care and Rehab (Kansas) — 100% antipsychotic prescribing rate
- Eskridge Care and Rehab (Kansas) — 93.6% antipsychotic prescribing rate
- Avantara Saint Cloud (South Dakota) — 55.5% antipsychotic prescribing rate
These are CMS Quality Measure 481 rates (long-stay residents receiving antipsychotic medication), derived from MDS data and published on Care Compare. The numbers describe what the current operators are reporting. Anyone can verify them on the facility pages linked above.
I raised the antipsychotic measurement gap in my public comment to CMS on the CRUSH RFI and in a letter to the OIG's Deputy Inspector General sent four days after the March 2026 reports were published. As a practicing psychiatric NP with prescribing authority, I can attest that a 100% antipsychotic prescribing rate at any facility warrants clinical review.
The Florida pattern: related-party costs in the millions
Five former Skyline facilities in Florida — now operated under the Aston Health chain, linked to Leopold Friedman — report some of the highest related-party transaction costs in the dataset. Related-party transactions are payments from a facility to commonly owned entities such as management companies, therapy vendors, or real estate holding companies, disclosed annually on HCRIS cost reports (Worksheet A-8).
- Oak Haven Rehab and Nursing Center — $4,353,943 in related-party costs (FY2024). CMS stars: 1/5.
- Fouraker Hills Rehab and Nursing Center — $4,178,700. CMS stars: 3/5.
- Kensington Gardens Rehab and Nursing Center — $3,670,307. CMS stars: 2/5.
- Sandgate Gardens Rehab and Nursing Center — $3,658,228. CMS stars: 2/5.
- Sea Breeze Rehab and Nursing Center — $3,270,036. CMS stars: 3/5.
These five facilities alone account for $19.1 million in related-party costs in a single reporting year. Related-party transactions are not inherently fraudulent — they are a normal feature of multi-facility healthcare operations. But the CRUSH RFI specifically asks about systematic monitoring of these figures at the chain level, because chain-level patterns are invisible when facilities are examined individually. That is exactly what I proposed in my CRUSH RFI public comment.
The full list
The table below shows all 56 former Skyline Healthcare facilities, sorted by composite risk score (highest risk first). Every CCN links to the facility's full enforcement profile on OversightReports.com. Stars, penalties, zero-RN percentages, and related-party costs reflect current data, not the Schwartz era.
| Facility | State | Stars | Risk | Fines | Zero-RN% | Related-Party |
|---|---|---|---|---|---|---|
| Wyndmoor Hills | PA | 1 | 65.1 | $102,309 | 2.2% | $835,821 |
| Emerald Omaha | NE | 1 | 64.8 | $169,318 | 6.5% | $516,875 |
| Monument Rehab | NE | 1 | 62.0 | $68,398 | 9.8% | $837,307 |
| Avantara Arrowhead | SD | 1 | 60.9 | $47,981 | 0.0% | $287,817 |
| Harborview Lansdale | PA | 2 | 58.2 | $191,228 | 0.0% | $1,415,295 |
| Avantara Milbank | SD | 1 | 54.8 | $55,361 | 0.0% | $273,633 |
| Avantara Pierre | SD | 2 | 54.0 | $33,920 | 0.0% | $399,336 |
| Avantara Redfield | SD | 1 | 54.0 | $30,051 | 18.5% | $52,972 |
| Avantara Saint Cloud | SD | 1 | 53.8 | $11,408 | 5.4% | $257,541 |
| Phoenix Center | PA | 2 | 51.9 | $40,095 | 12.0% | $1,257,531 |
| Harborview Doylestown | PA | 1 | 50.6 | $104,811 | 0.0% | $1,245,296 |
| Lincoln Care & Rehab | KS | 1 | 50.5 | $47,456 | 0.0% | $293,902 |
| Eskridge Care & Rehab | KS | 1 | 45.7 | $13,397 | 4.3% | $400,606 |
| Avantara Groton | SD | 3 | 44.1 | $28,418 | 15.2% | $190,421 |
| Rose City Lancaster | PA | 2 | 43.3 | $85,790 | 0.0% | $388,422 |
| Kaw River Care & Rehab | KS | 1 | 42.1 | $0 | 12.0% | $112,086 |
| Prestige Nebraska City | NE | 1 | 41.8 | $15,625 | 6.5% | $549,996 |
| Lansing Care & Rehab | KS | 3 | 40.2 | $9,654 | 44.6% | $456,858 |
| Barnes Healthcare | AR | 2 | 39.7 | $34,623 | 0.0% | $102,765 |
| Edwardsville Care & Rehab | KS | 3 | 39.4 | $9,113 | 0.0% | $311,366 |
Showing top 20 of 56 facilities by composite risk score. Full data for all 56 facilities is available on OversightReports.com — search by facility name or CCN.
What the 18 attorneys general said
On February 4, 2026, 18 state attorneys general sent a letter to CMS urging the agency to consider for-profit staffing mandates to curb fraud. The letter specifically named Schwartz, Skyline Healthcare, and Philip Esformes as examples of why enhanced enforcement is necessary. It cited private equity ownership research estimating a 10% increase in mortality and approximately 22,000 excess deaths over 12 years in PE-owned facilities. It called out related-party real estate arrangements, management fees to affiliates, and collusive loan structures. (Skilled Nursing News, February 4, 2026)
The same administration that pardoned Joseph Schwartz in November 2025 received that letter from 18 attorneys general in February 2026 citing him as the reason enforcement needs to be stronger.
What comes next
This post showed where Skyline's facilities went. The next post examines something narrower: what CMS ownership records show about former Skyline personnel who are still listed in active facility management roles today, and about Schwartz family members with current ownership interests.
The data is on the facility pages. Click through and look for yourself.
Source index
All primary sources referenced in this post:
Government documents
- OIG: Nursing Homes Inappropriately Diagnosed Residents with Schizophrenia (March 2026)
- Mass.gov: Skyline Healthcare wage theft citations
OversightReports.com facility pages
- Wyndmoor Hills (396115), Emerald Omaha (285097), Monument Rehab (285095), Avantara Arrowhead (435051)
- Oak Haven FL (105302), Fouraker Hills FL (105707), Kensington Gardens FL (105453), Sandgate Gardens FL (105382), Sea Breeze FL (105399)
- Edwardsville KS (175245), Eskridge KS (175455), Avantara Saint Cloud SD (435060)
- All 56 facilities searchable at oversightreports.com
Robert Benard's submissions
- CRUSH RFI public comment (March 30, 2026)
- Letter to HHS OIG Deputy Inspector General Ann Maxwell (March 23, 2026)
News coverage
- ProPublica: Schwartz/Skyline pardon investigation (March 30, 2026)
- Skilled Nursing News: Schwartz pardon (November 2025)
- Skilled Nursing News: 18 AGs letter (February 4, 2026)
- NBC News: Skyline collapse (2019)
- Arkansas Advocate: Schwartz state sentence (December 2025)
- KELOLAND: Former Skyline owners still own nursing homes (2022)
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