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Universal Health Services to pay $117M to settle allegations involving improper admissions, discharges

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Virginia has joined 49 other states, territories, and the federal government to settle allegations of fraud against Universal Health Services Inc. and UHS of Delaware Inc.

As part of the settlement, UHS Inc. will pay $117 million to resolve allegations that its hospitals and other facilities submitted false claims to Medicare, Medicaid, and other federal healthcare programs for inpatient behavioral health treatments that were medically unnecessary or not reasonable.

Additionally, UHS Inc. failed to provide appropriate or adequate services for both adults and children who were admitted to its facilities.

As part of the settlement, Virginia’s Medicaid program will receive $6,208,526, of which $3,604,922 represents the Commonwealth’s portion of the recovery.

UHS Inc. owns and provides management and administrative services for inpatient and residential psychiatric and behavioral health facilities that provide services to individuals, including beneficiaries of various federal healthcare programs.

UHS of Delaware Inc. is a subsidiary of UHS Inc. that provides management services to UHS, Inc. and many of its subsidiaries.

UHS is based in King of Prussia, Pa., and is one of the nation’s largest providers of hospital and healthcare services.

“Healthcare fraud on a massive scale like this is utterly egregious not only because it wastes millions of taxpayer dollars, but it undermines a crucial system that provides millions of Virginians with important healthcare services,” Attorney General Mark Herring said. “For over a decade UHS defrauded the Medicaid system and put profits and lining their own pockets over the wellbeing and care of their patients. I’m incredibly proud of my Medicaid Fraud Unit for their hard work on this really important case and we will continue to collaborate with state and federal partners to hold businesses accountable for fraud and abuse in Virginia and around the country.”

The settlement resolves allegations that during the period from Jan. 1, 2007, through Dec. 31, 2018, UHS and many of its entities submitted false claims for services provided to Medicaid beneficiaries resulting from UHS’s:

  • admission of beneficiaries who were not eligible for inpatient or residential treatment
  • failure to properly discharge beneficiaries when they no longer needed inpatient or residential treatment
  • improper and excessive lengths of stay
  • failure to provide adequate staffing, training, and/or supervision of staff
  • billing for services not rendered
  • improper use of physical and chemical restraints and seclusion
  • failure to provide inpatient acute or residential care in accordance with federal and state regulations, including, but not limited to, failure to develop and/or update individualized assessments and treatment plans, failure to provide adequate discharge planning, and failure to provide required individual and group therapy.

The coalition alleges that UHS’s conduct violated the Federal False Claims Act and the Virginia Fraud Against Taxpayers Act, resulting in the submission of false claims to the Virginia Medicaid program.

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