Massachusetts Attorney General Maura Healey
July 14, 2020
Universal Health Services will pay Mass. more than $15M to resolve false claims cases
Universal Health Services, a hospital management company based in Pennsylvania, will pay out more than $15 million to Massachusetts to resolve two different sets of accusations of improperly billing the Massachusetts Medicaid program, known commonly as MassHealth, Attorney General Maura Healey’s office announced on Monday.
The false claims submitted to MassHealth were for mental health services between 2009 and 2017, at outpatient centers in Franklin and Worcester, as well as Allston, Fall River, Haverhill, Lawrence, Lowell, Malden, Norwell and Woburn, according to a press release from the AG’s office.
“This company routinely allowed unqualified and unsupervised mental health professionals to provide care to patients and improperly billed MassHealth for it,” Healey said in a statement.
Under the first settlement, UHS and its affiliates - UHS of Delaware, Inc and HRI Clinics, Inc. - will pay $10 million to resolve allegations in two lawsuits. According to a press release, the AG’s office, along with whistleblowers, accused the company of submitting claims for services provided by unlicensed or non-independently licensed staff who were not properly supervised, as well as for medications prescribed by improperly supervised psychiatric nurses, for services performed by psychologists who were unlicensed, unsupervised and unqualified, and for employing clinicians with inadequate credentials.
The second settlement relates to allegations of fraud regarding UHS’s inpatient and residential psychiatric and behavioral health facilities, according to the AG’s office. Massachusetts joined other states and the federal government in the settlement, which is valued nationally at $117 million. Massachusetts will receive roughly $5.5 million from the payout.
The settlement aims to resolve allegations that UHS submitted claims to government healthcare programs for services provided to Medicaid beneficiaries who were not eligible for inpatient or residential treatment, according to a press release.
The fraud allegedly took place between 2007 and 2018.
UHS was also accused of improperly discharging beneficiaries who no longer needed inpatient or residential treatment, and for failing to provide adequate staffing, training and supervision for staff, billing for services that weren’t rendered and improperly using physical and chemical restraints.
The second lawsuit was the product of 18 whistleblower lawsuits filed in federal courts throughout the country, according to a press release.
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