During the COVID-19 pandemic, to conserve hospital beds, the Centers for Medicare and Medicaid Services waived the requirement that a person must have had a hospital stay of at least three days (signaling an acute illness or injury) before reimbursing for skilled care in a nursing home.
The United States and the State of California alleged that the defendants knowingly misused this waiver by routinely submitting claims for nursing home residents when they did not have COVID-19 or any other acute illness or injury, but merely had been near other people who had COVID-19. Under the settlement, the defendants will pay $6,841,727 to the United States and $242,273 to the State of California, plus interest.
“False claims are anathema to the Medicare system, especially during a public health crisis,” said United States Attorney Martin Estrada of the Central District of California. “This settlement agreement highlights my office’s determination to ensure our nation’s health care programs help those who actually need them.”
“The Department of Justice is committed to protecting the integrity of taxpayer-funded programs,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Department of Justice’s Civil Division. “We will hold accountable those who sought to defraud such programs during the COVID-19 pandemic, including those who knowingly misused emergency waivers for personal gain.”
This investigation was prompted by a lawsuit filed under the whistleblower provisions of the False Claims Act, which permit private parties to sue on behalf of the government to redress false claims for government funds and to receive a share of any recovery. The settlement agreement in this case provides for the whistleblower, Bay Area Whistleblower Partners, to receive $1,204,280, plus interest, as its share of the settlement. 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.).
Assistant United States Attorney Karen Y. Paik of the Civil Division’s Civil Fraud Section and Senior Trial Counsel Albert P. Mayer of the Justice Department’s Civil Division, Commercial Litigation Branch, Fraud Section are handling this matter with assistance from the Department of Health and Human Services’ Office of Inspector General and the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse.
The claims settled by the United States and the State of California are allegations only, and there was no determination of liability.
Source: U.S. Justice Department press release
- Brad Haugaard
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