Past Cases

COVID-19 Waiver Program FCA Litigation

Status Past Case

Practice area Whistleblower

Court U.S. District Court, Central District of California

Case number 2:20-cv-09472


On April 26, 2024, the U.S. Department of Justice and the State of California announced that they had reached a $7,084,000 civil settlement with ReNew Health Group LLC, ReNew Health Consulting Services LLC and two corporate executives for knowingly submitting false Medicare claims for nursing home residents in a first-of-its-kind False Claims Act case related to the COVID-19 Waiver Program.  This settlement resolved allegations brought by Cohen Milstein’s whistleblower clients in a qui tam lawsuit. 

The whistleblowers alleged that ReNew Health, which owns and operates dozens of nursing facilities throughout California, submitted millions of dollars of false claims to Medicare and California Medicaid under a COVID-19 waiver program for skilled care beginning at the start of the pandemic in March 2020.

The whistleblowers brought their lawsuit in California federal court in 2020.  For their successful efforts, the whistleblowers are entitled to receive an award of $1,204,280, plus interest.

Case Background

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.

In their False Claims Act qui tam action, 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.

The whistleblower lawsuit prompted an investigation by the U.S. Department of Justice and the California Department of Justice’s Division of Medi-Cal Fraud and Elder Abuse. This investigation culminated in the first False Claims Act settlement regarding fraud in the COVID-19 Waiver Program.