Will Nursing Home Chain Be Off the Hook for Paying Injury and Death Settlements?

Senator Elizabeth Warren (D-Mass) is set to reintroduce the Corporate Crimes in Health Care Act — legislation that authorizes criminal and civil penalties for private equity owners of healthcare organizations when their actions cause the injury or death of patients under their care. It is the toughest legislation to date designed to curb the worst excesses of Wall Street owners in healthcare.

The timing is right.

On December 10, a bankruptcy court will decide whether private equity owners behind one of the country’s largest nursing home chains — the Pennsylvania-based Genesis HealthCare — will be able to use the bankruptcy process to rid itself of millions in debts and obligations to residents and their families, workers, and vendors. More than 200 lawsuits against Genesis — alleging malpractice, wrongful death or other injury — have been put on hold during the bankruptcy proceedings. Genesis was spending $8 million a month to litigate and settle those cases before it filed for bankruptcy in July 2025, according to court filings. Genesis’s history of healthcare violations and the tragic stories of residents who have died as a result of neglect and mismanagement are emerging.

If the court rules in favor of the Genesis owners, then residents’ families and other claimants would lose the chance to pursue their malpractice and other claims against the company, estimated at some $150 million. As a result, they have asked the bankruptcy court to delay its decision and appoint an examiner to investigate the sales process — arguing that the process favored an ‘insider’ bid. During the November auction of the company’s assets, the bankruptcy’s “Special Restructuring Committee” — consisting of three people hired by Genesis — decided in favor of the inside bidder, referred to as CPE 889988, even though another company Genie 3 Partners, LLC offered a higher competitive bid.

Tracing the Genesis Story

The financial gymnastics to accomplish this feat are complex and murky.

At the center of this plot appears to be Joel Landau. He is founder and owner of ReGen Healthcare, a company ‘affiliated’ with his private equity firm, Pinto Capital Partners. ReGen is the primary owner of Genesis. Joel Landau also is behind the insider bidder; ‘CPE 889988,’ which is owned by WAX Dynasty Partners, according to the bankruptcy documents; and Joe Landau owns WAX Dynasty. Landau has a storied history of stripping assets from other nursing homes. Senators Warren and Richard Blumenthal (D-Conn), and Representative Maggie Goodlander (D-N.H.) have investigated Genesis and Joel Landau: In an October, 2025 letter, they chronicle the company’s and Landau’s history, financial tactics, and evidence of ongoing neglect and injury to residents.

Joel Landau took control of Genesis in 2021, when the chain faced bankruptcy due to years of private equity ownership and extraction of wealth — despite the fact that it received $665 million in COVID relief funding. Landau’s ReGen bailed out the company with a $100 million cash infusion and later another $25 million. In exchange, ReGen received a 93 percent equity stake in Genesis and the right to appoint three members to the Board of Directors — essentially taking control of the company’s strategic decisions. The company’s financials continued to plummet, as did its patient quality ratings.

On July 9, 2025, Genesis Healthcare filed for Chapter 11 bankruptcy when it reported $2.3 billion in debt. The bankruptcy affects over 15,000 residents and 27,000 employees in 200 skilled nursing facilities and senior living centers across 18 states.

The story has a deep history, as explained in the bankruptcy documents. In 2007, private equity firms Formation Capital and JER partners bought Genesis in a leveraged buyout worth roughly $2 billion that loaded the chain with excessive debt. Four years later, the PE owners sold all of Genesis’ real estate for $2.4 billion to a Health Care Real Estate Investment Trust (REIT HCN, later Welltower). The proceeds went to Genesis’ PE owners and investors, but not to the nursing homes.

Loaded with debt and paying high rent on property it used to own, Genesis’s financials plummeted. In 2015, it tried to save itself through a reverse merger with Skilled Healthcare Group, a large publicly-traded nursing home chain; but that group also had sold most of its real estate. The deal created one of the largest and most highly indebted chains in the country, with 500 facilities at its peak in 2016.

Despite assurances to investors that Genesis was still financially stable, it wasn’t — as its record showed. Between 2011 and 2025, it was charged with $14 million in nursing home violations and $2.4 million in employment-related ones. In 2017, Genesis paid $54.2 million to settle claims that it fraudulently overcharged Medicare and Medicaid. It couldn’t keep up with rent to its landlords, and by 2018, Genesis’s stock traded at less than $1 for some 30-day periods, leading to threatened stock delistings by the New York Stock Exchange. Facing bankruptcy, Genesis voluntarily delisted from the NYSE in 2021 and, as indicated earlier, was saved by a cash infusion of $100 million from ReGen — owned by Joel Landau’s PE firm Pinta Capital Partners. In exchange, ReGen took a 93 percent equity stake in Genesis and acquired the right to appoint two board members — and a third board member in 2023 when it provided an additional $25 million. ReGen controlled Genesis. Landau’s WAX Dynasty Partners also assumed over $50 million of Genesis’ debt in 2024.

These transactions positioned Landau, with controlling interests in ReGen and Wax Dynasty, to come out on top in the likely event of a bankruptcy. When Genesis filed for bankruptcy in July, it did so in a Texas district court known for favoring the owners. The judge agreed to allow the inside bidder to be the preferred, or ‘stalking horse’ bidder, for the company’s assets, a process that would provide it with favorable conditions. Only later was it revealed that the insider was owned by WAX Dynasty. The judge also agreed to a ‘fast track’ process in which assets of the bankrupt company may be sold quickly — which reduces the opportunity for vendors, workers and their pension funds to get what is owed to them, and for patients’ families with malpractice lawsuits to claim damages. The company quickly rids itself of these obligations.

On December 10, a Texas judge will decide in a final hearing whether Joel Landau gets away with acquiring the assets of Genesis. The 1,000 companies and people who have filed a total of $1.6 billion in claims against the company would lose.

Private Equity’s Familiar Story

The story is too familiar: Private equity owners treating nursing homes as financial assets to be bought, managed for cash, and sold — with patients, families, and workers bearing the costs. Patient care at Genesis HealthCare deteriorated as a series of private equity owners extracted millions through financial exploitation for almost two decades.

The Genesis debacle comes on the heels of three other catastrophic healthcare bankruptcies driven by private equity greed: Steward Hospital, with 40 hospitals and over 30,000 employees at its height; Prospect Medical Holdings, with almost 20 hospitals and thousands of employees; and HCR ManorCare, with almost 500 facilities and 60,000 employees at its height. In each case, PE owners extracted billions and exited without penalty or accountability for the financial ruin of their healthcare entities, the layoffs of thousands of workers, and the thousands of patient injuries and in some cases death. The most credible academic research to date shows that private equity ownership of nursing homes has led to, 11 percent higher Medicare charges and 10 percent higher mortality rates — linked to excessive understaffing and 50 percent higher use of antipsychotic drugs, which are associated with higher mortality. Private equity firms were responsible for seven of the eight largest healthcare bankruptcies in 2024 and 21 percent of all healthcare bankruptcies in the country.

It’s time to hold the PE owners of healthcare companies accountable for extracting resources for themselves rather than for patients.