Universal Health Services: The $117 Million Care Settlement Behind Eighteen Actions

In the Universal Health Services fraud case, UHS agreed to pay $117 million to resolve allegations of medically unnecessary psychiatric admissions, excessive stays and care billed but never delivered. The government’s allegations reached decisions that nurses, therapists, utilization reviewers and billing staff would recognize: who needed a bed, who was ready to leave, and what treatment actually happened while the bills kept going out.

The Department of Justice announced the settlement on July 10, 2020. It brought together eighteen whistleblower actions over inpatient and residential behavioral health services for adults and children. Medicare, Medicaid, TRICARE, the federal employee health benefits program and the Department of Veterans Affairs were among the payers. The alleged practices shortchanged patients who needed treatment and taxpayers paying for their care.

UHS Owned the Facilities, UHS of Delaware Managed Them

UHS owned the psychiatric and behavioral health facilities, while UHS of Delaware provided management services. The settlement agreement identifies those roles separately and lists the covered facilities in its exhibits.

At the time of the announcement, the Justice Department described UHS as owning and providing management and administrative services to nearly 200 inpatient psychiatric hospitals and residential treatment facilities nationwide. Its headquarters were in King of Prussia, Pennsylvania.

For someone inside a facility, the distinction between ownership and management has a practical use. We look at who made the admission and discharge decisions, who supervised the staff, and how those decisions reached the claim.

Unnecessary Admissions and Delayed Discharges

The government alleged that UHS facilities admitted people whose conditions did not require inpatient or residential treatment and kept appropriately admitted patients after they no longer needed that level of care. The allegations covered both entry into the facility and the later decision to keep billing for a stay.

Medicare’s inpatient psychiatric payment system pays qualifying facilities by the day, with adjustments for the patient and facility. Admission assessments, continuing-care reviews and discharge decisions therefore sit close to the revenue.

That connection gives the unnecessary-stay allegation its force. A patient ready to leave can still occupy a billable bed. The government alleged that UHS failed to discharge patients when inpatient care was no longer needed and billed for improper and excessive stays.

Missing Therapy, Thin Staffing and the Claim for Care

The care allegations also concerned what happened during the stay. The government alleged that UHS billed for services it did not provide, failed to supply required individual and group therapy, and failed to develop or update individualized assessments and treatment plans.

Staffing was part of that account. The agreement describes alleged failures to provide adequate staffing, training and supervision, together with improper use of physical restraints, chemical restraints and seclusion. It also covers inadequate discharge planning.

These allegations reach several different views of the same day. A therapist knows whether a session happened. A supervisor knows who was available to deliver it. A utilization reviewer sees the account of why the patient still needs inpatient care. A biller sees what the payer was asked to fund. Our work is to connect those views to the particular treatment and claim.

The government’s case described patients allegedly receiving too little care while public programs paid for treatment. An occupied bed and a completed billing record can conceal the missing work between them.

Which Facilities and Service Dates Did the Agreement Cover?

The agreement used different covered periods for different facility groups and payers. Its facility lists and covered periods put Behavioral Hospital of Bellaire, Havenwyck Hospital and The Hughes Center in Exhibit A. Exhibit B includes Alabama Clinical Schools and Alliance Health Center.

Ownership changed during those periods. UHS acquired marked facilities from Ascend Health Corp. on October 10, 2012, and from Psychiatric Solutions on November 15, 2010. The agreement expressly includes some alleged conduct from before UHS acquired the facilities.

That history matters to an employee who knows a facility under an earlier owner or name. The facility, payer and service date locate the claim. The acquisition date helps locate the people and management systems responsible for the work at that time.

Eighteen Whistleblower Actions, One Care Agreement

Whistleblowers brought the eighteen qui tam actions that the care settlement resolved.

The care agreement brought those healthcare billing cases into a common resolution. The company-wide result grew out of separate cases, and the agreement supplied a shared whistleblower fund.

Why the Announcements Used Different Settlement Amounts

The Justice Department’s $122 million headline combined the care agreement with a separate $5 million settlement involving Turning Point Care Center in Moultrie, Georgia. Turning Point’s separate case concerned transportation used to attract patients.

The government alleged that Turning Point provided free or discounted transportation to induce Medicare and Medicaid beneficiaries to use its inpatient detoxification and rehabilitation program or intensive outpatient program. That settlement resolved an additional whistleblower lawsuit. Its central question was how patients were induced to attend. The care agreement addressed admission, continuing need and the services provided.

Outside Review of Patient Care and Claims

The settlement also brought a five-year corporate integrity agreement with the Department of Health and Human Services Office of Inspector General. Under the requirements announced with the settlement, UHS had to retain an independent monitor selected by the inspector general to assess patient-care protections and report back to the agency. A separate independent review organization had to review inpatient behavioral health claims annually.

That division followed the two sides of the case: the treatment patients received and the claims public programs paid.

A Separate UHS Complaint Put Missing Care Into Plain Sight

The separate government complaint concerning Keystone Marion Youth Center alleged overstated therapy and false treatment plans used to obtain authorization codes for UHS central billing staff to bill Medicaid for room and board.

In UHS’s separate Supreme Court case, the Court recounted allegations that Arbour Counseling Services used unlicensed, unsupervised staff to treat patients. Arbour allegedly billed Medicaid using service codes and provider identifiers that concealed the staff’s missing qualifications.

What Evidence Is Needed to Prove Fraud?

For the practices alleged here, the evidence connects the patient’s need, the care actually delivered and the claim for payment. Admission assessments, treatment plans, therapy records, staffing records and discharge decisions tell different parts of that story. We work with insiders to determine how those parts fit the payer’s bill and the decisions inside the business.

The corporate connection matters too. The UHS agreement covered claims the companies submitted or caused to be submitted. The person submitting the claim and the person creating its clinical support can work in different places.

Your knowledge may concern the treatment itself, the instruction to document it a certain way, or the response when someone questioned the bill. We assess that knowledge with you and bring the clinical and payment issues to behavioral health whistleblower lawyers who understand hospital billing cases.

How Much of a Settlement Does a Whistleblower Get?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

The UHS agreement allocated $15.9 million to the whistleblowers collectively, from the federal settlement payment.

You Saw the Care Behind the Claim

If you saw patients kept after they were ready to leave, therapy recorded that never happened, or staffing decisions that left billed care undelivered, speak with our whistleblower experts. We build the case with you around what the facility did, what management knew and what the government paid, then bring in behavioral health whistleblower lawyers with the experience that case needs. We remain your partners through the pursuit of the recovery.