Company with psychiatric facilities in Hampton Roads agrees to pay $117M settlement for alleged false billing

National

HAMPTON ROADS, Va. (WAVY) — Universal Health Services, the parent company of some psychiatric facilities in Hampton Roads, has agreed to pay a $122-million settlement for allegedly making false billing claims.

While UHS did not admit to any crime — the settlement does not determine liability in the allegations against UHS — the company will pay $177 million to settle claims that it billed for unnecessary inpatient behavioral health services, didn’t provide adequate and appropriate services and paid illegal inducements to federal healthcare beneficiaries, according to a Department of Justice news release.

The false claims were allegedly made to Medicare, Medicaid, TRICARE, Department of Veterans Affairs, and Federal Employee Health Benefit programs.

Pennsylvania-based UHS owns and provides administrative services for nearly 200 psychiatric and behavioral treatment facilities nationwide, including in Newport News and Norfolk. Its website also lists facilities in Portsmouth and Virginia Beach.

In the settlement, UHS’s facility in Moultrie, Georgia, Turning Point Care Center, LLC, also agreed to pay a separate $5 million for alleged violations at that particular facility, including giving free or discounted transportation services to encourage Medicare- and Medicaid-covered individuals to seek treatment at Turning Point’s inpatient detoxification and rehabilitation program or intensive outpatient program.

Of the $122-million settlement, the federal government will receive a total of $88,124,761.27. States will receive a total of $28,875,238.73. Together, those parts of the settlement jointly fund state Medicaid programs.

The $5 million from Turning Point will be paid to the State of Georgia and the United States.

The Department of Justice says UHS and its facilities were accused of several violations between 2006 and 2018, to include:

  • Admitting federal healthcare beneficiaries who were not eligible for inpatient or residential treatment because their conditions did not require that level of care,
  • Failing to properly discharge appropriately admitted beneficiaries when they no longer required inpatient care. 
  • Billing for services not rendered
  • Billing for improper and excessive lengths of stay
  • Failing to provide adequate staffing, training, and/or supervision of staff,
  • Improperly using physical and chemical restraints and seclusion.  
  • Failing to develop and/or update individual assessments and treatment plans for patients
  • Failing to provide adequate discharge planning
  • Failing to provide required individual and group therapy services in accordance with federal and state regulations

“The Department of Justice is committed to protecting patients and taxpayers by ensuring that the treatment provided to federal healthcare beneficiaries is reasonable, necessary, and free from illegal inducements,” said Acting Assistant Attorney General Ethan P. Davis for the Department of Justice’s Civil Division.  “The Department will continue to be especially vigilant when vulnerable patient populations are involved, like those served by behavioral healthcare providers.”

For the next five years, UHS will be overseen by an independent monitor selected by the Office of the Inspector General. That monitor will assess UHS’s patient care and report back to the OIG.

An independent review organization will also annually review UHS’s claims to federal health care programs.

Virginia-based law firm Breit Cantor “was instrumental in resolving the litigation,” the law firm, which has offices in Virginia Beach and Richmond, announced Monday night. It also was the first firm to file against the Virginia facilities.

“The ultimate goal of quality treatment and fair billing is important for all patients and this settlement assures that future conduct of UHS at the Virginia facilities and other facilities will be appropriate. It was an honor to have played a part in helping resolve this litigation with a substantial payment by UHS,” said Jeffrey Breit, of Breit Cantor, in the law firm’s news release.


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