Home » Ky.’s Medicaid receives nearly $1M settlement

Ky.’s Medicaid receives nearly $1M settlement

Allegations involve improper admissions, discharges at inpatient and residential health care facilities

FRANKFORT, Ky. — Kentucky’s Medicaid Program will receive $929,016 as part of a settlement regarding allegations of fraud against Universal Health Services Inc., a for-profit holding company, which directly or indirectly owns the assets or stock of inpatient and residential psychiatric and behavioral health facilities, and UHS of Delaware Inc., a subsidiary of UHS, which provides management services to UHS, Inc. and its subsidiaries, Attorney General Daniel Cameron announced Monday.

UHS is based in King of Prussia, Pa., and is one of the nation’s largest providers of hospital and healthcare services. The government alleges that UHS’s conduct violated the Federal False Claims Act and Kentucky’s Medicaid Fraud statute, resulting in the submission of false claims to the Kentucky Medicaid program.  Cameron joined with 47 other states, one territory, the District of Columbia, and the federal government in the $117 million settlement.

“Medicaid fraud takes a toll on the state’s Medicaid program and can ultimately raise costs for taxpayers who help fund the program as well as cause harm to beneficiaries,” said Cameron. “Our office frequently collaborates with other states to stop widespread Medicaid abuse and investigate allegations of fraud, like those raised against UHS. We urge Kentuckians to report suspected fraud to our Medicaid Fraud and Abuse Hotline at 1-877-ABUSE TIP (1-877-228-7384).”

The settlement resolves allegations that during the period from Jan. 1, 2007, through Dec. 31, 2018, UHS and certain UHS entities submitted or caused to be submitted false claims for services provided to Medicaid beneficiaries.  These services included (i) admission of beneficiaries who were not eligible for inpatient or residential treatment, (ii) failure to properly discharge beneficiaries when they no longer needed inpatient or residential treatment, (iii) improper and excessive lengths of stay, (iv) failure to provide adequate staffing, training, and/or supervision of staff, (v) billing for services not rendered, (vi) improper use of physical and chemical restraints and seclusion; and (vii) 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.

This settlement results from eighteen whistleblower lawsuits originally filed in the United States District Court for the Middle District of Florida, Northern District of Illinois, Eastern District of Pennsylvania, Northern District of Georgia, Middle District of Georgia, Eastern District of Virginia, Western District of Virginia, Western District of Michigan, and Eastern District of Michigan. Fourteen of the eighteen whistleblower suits named at least one plaintiff state and all but three of the cases were transferred to the United States District Court for the Eastern District of Pennsylvania.

A National Association of Medicaid Fraud Control Units Team participated in the investigation and settlement negotiations on behalf of the states.  The team included representatives from the Offices of the Attorneys General for the states of California, Florida, Indiana, Massachusetts, North Carolina, Ohio, Texas, and Virginia.