Universal Health Services has agreed to a settlement with the Department of Justice to pay $122 million for alleged false claims for behavioral health treatments that were unnecessary and failed to provide adequate care for patients admitted to UHS facilities.
UHS, headquartered in Pennsylvania, owns and operates nearly 200 psychiatric hospitals and behavioral treatment facilities across the United States.
The company will pay $117 million to the federal government and some state governments for claims of payments to federal health care programs including Medicare and Medicaid. The government alleged that UHS admitted federal health beneficiaries for inpatient or residential when they did not require that level of treatment for their conditions between 2006 and 2018. UHS also allegedly failed to appropriately discharge admitted patients when they no longer required inpatient care.
The government also alleges that UHS billed for services not rendered and failed to provide adequate training and staff. The allegations of inadequate care also include inappropriate uses of physical and chemical restraints, failing to update individual treatment plans, and failing to provide individual and group therapy in accordance with regulations.
A UHS facility in Georgia will also pay $5 million to settle allegations that it provided free or discounted transportation services to incentivize Medicare and Medicaid recipients to seek treatment at the facility.
“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 in a statement. “The Department will continue to be especially vigilant when vulnerable patient populations are involved, like those served by behavioral healthcare providers.”
As part of the settlement, UHS has entered into a Corporate Integrity Agreement with the Office of the Inspector General lasting five years. UHS must retain an independent monitor selected by OIG who will perform annual reviews of the claims made by the behavioral health division and assess its patient care protections.
UHS denies the allegations, saying in a statement that “the settlement does not constitute a finding of improper conduct or failure to provide appropriate care and treatment in accordance with governing rules and regulations or an admission of facts or liability by the Company or any of its subsidiary behavioral health facilities.” Prosecutors said that there has been no determination of liability.
“UHS is pleased to have resolved 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. 
Stephanie Liu is assistant editor at Internal Audit 360°