April 26, 2024
Resolves fraud allegations regarding the COVID-19 Waiver Program
PHILADELPHIA, PA– National plaintiffs firm Cohen Milstein Sellers & Toll announced today that the United States and the State of California reached a $7 million settlement with ReNew Health Group LLC, ReNew Health Consulting Services LLC and its owner-CEO and its COO to resolve False Claims Act allegations filed by Cohen Milstein’s whistleblower clients. ReNew Health, which owns and operates dozens of nursing facilities throughout California, allegedly submitted millions of dollars of false claims to Medicare and California Medicaid under a COVID-19 waiver program beginning at the start of the pandemic in March 2020.
“This settlement is a reminder about the important role whistleblowers play in rooting out fraud in the healthcare industry,” said Gary Azorsky, chair of Cohen Milstein’s Whistleblower practice. “This case would not have been possible without the brave individuals who came forward to report improper Medicare claims.”
“Our clients are persons of integrity who stepped forward and brought an end to ReNew Health’s practice of overcharging Medicare and Medicaid,” said Ray Sarola, counsel for the whistleblowers and also a member of Cohen Milstein’s Whistleblower practice. “We thank the United States and the State of California for their diligent and thorough investigation of our clients’ allegations and for protecting taxpayers and government health care programs by recovering these substantial overpayments.”
Early in the COVID-19 pandemic, the Centers for Medicare and Medicaid Services (CMS) took emergency measures to free up hospital beds and temporarily waived the requirement that a person stay in a hospital for three days before Medicare Part A would cover skilled care in a nursing home that qualified as a skilled nursing facility (SNF). This meant that if a person who had Medicare Part A needed skilled care, the person could move directly into a nursing home that qualified as a SNF to receive that care – or if the person already lived in a nursing home that qualified as a SNF, the person could remain there and receive that care. The nursing home could then submit Medicare Part A claims on behalf of the person to get paid for providing that care. CMS also waived the 100-day limit on Medicare Part A coverage of such care under certain circumstances. These waivers expired in May 2023.
The whistleblowers alleged that beginning in March 2020, after learning of CMS’s waivers, ReNew Health submitted false Medicare and Medicaid claims representing that many residents in their nursing homes needed skilled care based on the possibility that they were exposed to COVID-19, in violation of the terms of the COVID-19 waiver program. Skilled care typically involves the treatment of severe illness or injuries, such as heart attacks, pneumonia, or significant orthopedic issues.
Cohen Milstein was pleased to work on this matter with co-counsel David Brevda of Senior Justice Law Firm and June Hoidal, Chuck Toomajian, and Caleb Marker of Zimmerman Reed LLP.
The federal False Claims Act and its state law equivalents permit private citizens to bring lawsuits on behalf of the government against persons who present false or fraudulent claims for payment under government contracts or programs, such as Medicare, Medicaid, TRICARE, and the FEHB Program. Whistleblowers, like those who brought this lawsuit, are entitled to receive a portion of the proceeds of any settlement or judgment awarded against a defendant.
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