In a groundbreaking resolution, ReNew Health Group LLC has agreed to a $7 million settlement to resolve allegations of submitting false Medicare claims, marking the largest COVID nursing home fraud case in US history.
Unveiling the Fraud:
The investigation, spearheaded by Senior Justice Law Firm partners David Brevda and Michael Brevda, uncovered fraudulent practices while probing a nursing home injury case. Representing the whistleblowers, Senior Justice Law Firm facilitated the qui tam action, leading to a $7,084,000 settlement under the False Claims Act (FCA).
What Is a Qui Tam Action?
A qui tam action under the False Claims Act allows private individuals, known as whistleblowers or relators, to sue on behalf of the government when they have knowledge of an entity committing fraud against federal programs. In return, these whistleblowers can receive a portion of the recovered funds as a reward for their role in exposing the fraud.
In the ReNew Health case, the whistleblowers, represented by Senior Justice Law Firm, brought the fraudulent activities to light, initiating a qui tam lawsuit.
Understanding COVID Medicare Fraud:
The alleged fraudulent activities centered around the misuse of Medicare Part A’s coverage of skilled nursing care. Medicare, the principal payor for most nursing home beds in the US, generally mandates a 3+ day hospital stay before reimbursing for skilled nursing care. However, the COVID-19 pandemic prompted Medicare to waive this requirement, allowing immediate reimbursement for COVID patients. Some operators exploited this waiver to file false claims.
Whistleblowers revealed that ReNew Health allegedly misrepresented the necessity of skilled care for numerous residents, citing potential COVID exposure, thus breaching the COVID-19 waiver program’s terms.
Senior Justice Law Firm’s Approach to Uncovering Nursing Home Fraud:
Experienced in injury and wrongful death claims against healthcare facilities, Senior Justice Law Firm extends its investigations beyond individual injuries to uncover broader systemic issues like corporate misconduct.
Nursing home understaffing and Medicare fraud often lead to neglect and harm. The firm’s attorneys scrutinize staffing records, financial transactions, and Medicare/Medicaid reimbursements to detect corporate malpractices. Interviews with former employees also play a crucial role in exposing fraudulent activities.
David Brevda’s meticulous work revealed ReNew Health’s scheme to defraud Medicare. Leveraging the firm’s strong ties with the US Department of Justice, Senior Justice Law Firm effectively collaborates with federal authorities to prosecute extensive fraud cases.
Key Insights from the ReNew Case:
The ReNew Medicare COVID waiver case underscores the necessity of stringent oversight to protect public funds and maintain the integrity of the long-term care system. Senior Justice Law Firm is honored to have worked with attorneys Ray Sarola, Albert Mayer, Karen Paik, and Susan Gillin, Zimmerman Reed LLP, and the Department of Health and Human Services’ Office of Inspector General to expose this significant fraud.
By promoting a culture of integrity and vigilance, we can prevent the misuse of trust placed in nursing homes. Justice must triumph over deceit and fraud.
“Transparency, accountability, and unwavering commitment to ethical practices are vital in healthcare,” emphasized David Brevda, Partner at Senior Justice Law Firm. “Elderly patients are not mere commodities for profit. They are our family members, deserving the utmost protection.”
Exposing corporate fraud is essential to safeguarding nursing home residents from abuse and neglect. Comprehensive investigations and collaborative efforts with the DOJ are crucial for instigating systemic changes, especially at an institutional level.
The claims settled by the United States and California are allegations only; no determination of liability has been made. The case is captioned United States and State of California ex rel. Bay Area Whistleblower Partners v. ReNew Health Group LLC et al., No. 2:20-cv-09472 (C.D. Cal.).
Contact Information:
Name: Michael Brevda
Email: EService@SeniorJustice.com
Job Title: Managing Partner
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