Two congressmen are pressing HHS on its investigation into the operations of Universal Health Services' behavioral facilities.
Reps. Joe Kennedy III (D-Mass.) and Danny Davis (D-Ill.) wrote a letter Tuesday to Andy Slavitt, CMS acting administrator, asking for an update on HHS' investigation and for information on any actions that the CMS or HHS plan to take.
“Given the serious allegations of fraud, negligence and staff retaliation, we have serious concerns about the welfare of patients,” the congressmen wrote.
UHS, a publicly traded system based in King of Prussia, Pa., said in a statement Tuesday that it has cooperated with investigating agencies and, “We remain confident in the operations of our behavioral health facilities and their continued efforts to provide the highest quality care.”
“UHS Behavioral Health Facilities have a long-term, demonstrated record of providing quality healthcare services to patients,” UHS said in its statement. “UHS facilities have been recognized by independent, third-party accreditation organizations for delivering high quality patient-focused care leading to positive health outcomes.”
UHS also noted the involvement of the Service Employees International Union, with which it's been involved in labor disputes. Kirk Adams, SEIU international executive vice president, praised the lawmakers' letter in a news release Tuesday.
The SEIU has also created a website about alleged problems at UHS, saying that UHS has achieved high profit margins by reducing staffing costs and keeping occupancy rates high. The website argues that “cutting staffing too low can endanger both patients and staff.”
“The SEIU's intervention in this matter is part of a highly targeted, misleading campaign against UHS initiated solely to serve their own financial benefit,” according to the UHS statement. “An unbiased review of the historical record reveals that UHS facilities have many more success stories to its credit than the isolated and misleading examples highlighted by the SEIU.”
UHS said in a 2013 report to the Securities and Exchange Commission that it had received a subpoena from HHS' Office of Inspector General requesting about five years of documents concerning 10 of its facilities.
At the time, UHS said it was “uncertain as to the focus, scope or extent of the investigations, liability of the facilities and/or potential financial exposure, if any.” Seven more UHS facilities later received subpoenas as well.
In their letter, the congressmen cite a series of articles published in the Boston Globe in 2013 and 2014 that they say documented “staffing failures, 'cutting corners,' negligent care, and even patient deaths across Arbour Health System facilities in Massachusetts.” They also cite a 2014 Chicago Tribune series “detailing violence, sexual assaults, patient runaways, and a lack of security staff at Rock River Academy in Illinois, Foundations for Living in Ohio, and other facilities.”
The U.S. Justice Department's criminal fraud section has also been investigating several UHS' facilities in recent years. In March, UHS disclosed that its corporate office had also become part of the criminal investigation into whether the company fraudulently billed Medicare and Medicaid for behavioral health treatments.
Phil Bezanson, a white-collar investigation partner at law firm Bracewell & Giuliani in Seattle, said these latest reports seem to be part of efforts to use sophisticated data analysis to identify fraud.
“When you have a lot of the same types of data coming in, it's really much simpler to spot patterns to identify areas where there are obvious deviations,” Bezanson said.
He said, however, some of the OIG's recommendations may not be as easy to implement as they were to make.
Ericka Adler, a healthcare partner at law firm Roetzel & Andress in Chicago, also said Tuesday she's not surprised that the CMS hasn't yet fully implemented all of the OIG's recommendations given the size of the Medicare Part D program.
Adler called the OIG's reports a step in the right direction but also cautioned that, in some cases, providers who might seem to be prescribing suspicious amounts of opioids or other drugs might have legitimate reasons for doing so. They might, for example, specialize in treating patients in a lot of pain. Some geographic areas might also pop up as “hot spots” for certain medications because doctors in those areas might be communicating with each other about their successes with certain types of drugs, she said.
“It paints a picture that's not the clearest picture,” Adler said of the reports' focus on potential areas of fraud, “Just reading it, I think it's alarming, but if you get a little more information it might be less alarming.”