Zimmerman Reed announces $7 million settlement for the U.S. and State of California in a first-of-its kind False Claims Act case involving a COVID-19 waiver program.
MINNEAPOLIS, Minn., April 29, 2024 /PRNewswire-PRWeb/ -- Zimmerman Reed 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 Zimmerman Reed's whistleblower clients. ReNew Health, the owner and operator of dozens of nursing facilities throughout California, allegedly submitted millions of dollars of fraudulent claims to Medicare and California Medicaid since March 2020 under a scheme involving a COVID-19 waiver program.
"This case emphasizes the vital contribution that whistleblowers can make in exposing healthcare fraud," said June Hoidal, chair of Zimmerman Reed's Whistleblower practice. "The courage of our clients who reported improper Medicare and Medicaid claims was instrumental in bringing this case to light and securing a just result."
"Along with the whistleblowers who uncovered these wrongdoings, we commend the United States and the State of California for thoroughly investigating these allegations and bringing this case to resolution," said Chuck Toomajian, counsel for the whistleblowers and a member of Zimmerman Reed's Whistleblower practice. "Their diligence resulted in recovering substantial overpayments and is critical in protecting taxpayers and government health care programs against these schemes."
To free up hospital beds during the COVID-19 crisis, the Centers for Medicare and Medicaid Services (CMS) temporarily waived its rule requiring a minimum three-day hospital stay before Medicare Part A would cover skilled care in a nursing home that qualifies as a skilled nursing facility (SNF). Due to this waiver, a person who had Medicare Part A and needed skilled care could move directly into a nursing home qualifying as an SNF to receive that care. Likewise, a person already living in a nursing home that qualified as an SNF could remain there to receive that care. Under either scenario, the nursing home could then submit claims for payment for providing that skilled care under Medicare Part A. CMS also waived the 100-day limit on Medicare Part A coverage of skilled care under certain circumstances. These waivers expired in May 2023.
The whistleblowers alleged that, after learning of these waivers, ReNew Health began submitting false Medicare and Medicaid claims for skilled care for residents in their nursing homes, basing the claimed need for skilled care on the possibility that the residents were exposed to COVID-19. Typically, skilled care involves the treatment of severe illness or injuries such as heart attacks, pneumonia, or significant orthopedic issues.
Zimmerman Reed was pleased to work on this matter with co-counsel Gary Azorsky and Ray Sarola of Cohen Milstein Sellers & Toll, and David Brevda of Senior Justice Law.
The federal False Claims Act and its state law equivalents empower private citizens to sue on the government's behalf against persons who present false claims for payment under government contracts or programs. Successful whistleblowers, like those who brought this lawsuit, are entitled to a share of any recovery obtained through settlement or judgment against a defendant.
Media Contact
Albert Leung, Zimmerman Reed, 1 612-341-0400, [email protected], www.zimmreed.com
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MINNEAPOLIS, Minn., April 29, 2024 /PRNewswire-PRWeb/ -- Zimmerman Reed 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 Zimmerman Reed's whistleblower clients. ReNew Health, the owner and operator of dozens of nursing facilities throughout California, allegedly submitted millions of dollars of fraudulent claims to Medicare and California Medicaid since March 2020 under a scheme involving a COVID-19 waiver program.
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"This case emphasizes the vital contribution that whistleblowers can make in exposing healthcare fraud," said June Hoidal, chair of Zimmerman Reed's Whistleblower practice. "The courage of our clients who reported improper Medicare and Medicaid claims was instrumental in bringing this case to light and securing a just result."
"Along with the whistleblowers who uncovered these wrongdoings, we commend the United States and the State of California for thoroughly investigating these allegations and bringing this case to resolution," said Chuck Toomajian, counsel for the whistleblowers and a member of Zimmerman Reed's Whistleblower practice. "Their diligence resulted in recovering substantial overpayments and is critical in protecting taxpayers and government health care programs against these schemes."
To free up hospital beds during the COVID-19 crisis, the Centers for Medicare and Medicaid Services (CMS) temporarily waived its rule requiring a minimum three-day hospital stay before Medicare Part A would cover skilled care in a nursing home that qualifies as a skilled nursing facility (SNF). Due to this waiver, a person who had Medicare Part A and needed skilled care could move directly into a nursing home qualifying as an SNF to receive that care. Likewise, a person already living in a nursing home that qualified as an SNF could remain there to receive that care. Under either scenario, the nursing home could then submit claims for payment for providing that skilled care under Medicare Part A. CMS also waived the 100-day limit on Medicare Part A coverage of skilled care under certain circumstances. These waivers expired in May 2023.
The whistleblowers alleged that, after learning of these waivers, ReNew Health began submitting false Medicare and Medicaid claims for skilled care for residents in their nursing homes, basing the claimed need for skilled care on the possibility that the residents were exposed to COVID-19. Typically, skilled care involves the treatment of severe illness or injuries such as heart attacks, pneumonia, or significant orthopedic issues.
Zimmerman Reed was pleased to work on this matter with co-counsel Gary Azorsky and Ray Sarola of Cohen Milstein Sellers & Toll, and David Brevda of Senior Justice Law.
The federal False Claims Act and its state law equivalents empower private citizens to sue on the government's behalf against persons who present false claims for payment under government contracts or programs. Successful whistleblowers, like those who brought this lawsuit, are entitled to a share of any recovery obtained through settlement or judgment against a defendant.
Media Contact
Albert Leung, Zimmerman Reed, 1 612-341-0400, [email protected], www.zimmreed.com
View original content:https://www.prweb.com/releases/renew-health-to-pay-7-million-to-settle-first-of-its-kind-covid-19-false-claims-act-case-302130624.html
SOURCE Zimmerman Reed
