Whistleblowers will receive a $16.7 million payday as part of a $122 million settlement between the Department of Justice (DOJ) and Universal Health Services (UHS), one of the nation’s largest hospital and healthcare service providers.
The settlement, announced Friday, settles a slew of False Claims Act (FCA) allegations against the company, many of which were brought to light by whistleblowers in federal lawsuits.
The DOJ announced the settlement covered allegations UHS violated the FCA by “billing for medically unnecessary inpatient behavioral health services, failing to provide adequate and appropriate services, and paying illegal inducements to federal healthcare beneficiaries.”
In an emailed statement, UHS said the settlement “is not an admission of liability, but merely a resolution of a civil claim.”
“UHS unequivocally disputes any allegation that it engaged in wrongdoing of any kind. … UHS was eager to resolve this matter to avoid future distractions and the high costs of litigation while ensuring that our focus remains steadfast on providing excellent care to our patients and their families,” the company said in its statement.
The company also agreed to a five-year corporate integrity agreement (CIA) overseen by a monitor chosen by the Office of Inspector General (OIG). The monitor will issue regular assessment reports to the OIG, while “an independent review organization will perform annual reviews of UHS’s inpatient behavioral health claims to federal health care programs,” the DOJ said.
UHS said the company’s existing compliance program “makes it well positioned to comply with the obligations of the CIA going forward.”
The settlement was broken into two parts. The majority of the settlement, $117 million, resolved allegations that UHS’s hospitals and facilities “knowingly submitted false claims for payment to the Medicare, Medicaid, TRICARE, Department of Veterans Affairs, and Federal Employee Health Benefit programs,” the DOJ said.
The DOJ alleged that, from 2006-2018, UHS admitted Medicare beneficiaries to higher-than-necessary levels of care and failed to discharge them when they no longer required such care. UHS was also accused of billing for services not rendered and for improper and excessive lengths of stay; failing to provide adequate staffing, training, and supervision of staff; and for improperly using physical and chemical restraints in seclusion. The UHS facilities also failed to develop adequate treatment plans for patients, adequate discharge planning, and adequate therapy services.
A separate $5 million settlement settled claims that one of UHS’s subsidiaries, Turning Point Care Center, provided free or reduced cost transportation to induce Medicare and Medicaid patients to receive detoxification and rehabilitation services at its facility in Moultrie, Ga.
The DOJ agreement with UHS settled 19 separate whistleblower lawsuits, filed in four federal courts in Georgia, Pennsylvania, and Michigan under the whistleblower provision of the FCA, known as qui tam.
“Providing top quality health care to service members and their beneficiaries is the primary mission of the Defense Health Agency. It’s unfortunate a company tried to take advantage of a system that ensures health care for those men and women who are on the front lines every day protecting our nation,” said Lt. Gen. Ronald Place, director of the Defense Health Agency, in the DOJ statement.
Headquartered in King of Prussia, Pa., UHS has 90,000 employees who staff 354 inpatient acute care hospitals and behavioral health facilities and 42 outpatient and other facilities, located throughout the United States as well as Puerto Rico and the United Kingdom.