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April 11, 2017 01:00 AM

Massachusetts Medicaid program sues UHS for false claims

Modern Healthcare
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    The state of Massachusetts sued Universal Health Services in federal court Monday, accusing it of illegally charging Medicaid for outpatient mental health care by unqualified staff.

    UHS this year has faced scrutiny and subsequent financial losses after a BuzzFeed investigation alleged the for-profit hospital operator kept psychiatric patients longer than necessary to milk their insurance.

    Massachusetts' complaint will be added to that of Julio Escobar and Carmen Correa, who first filed suit on behalf of their daughter who died at a UHS facility.

    The state alleges that UHS submitted false claims to MassHealth program, charging for mental healthcare given by unlicensed personnel, which is required by Medicaid.

    The complaint claims that UHS had a culture of noncompliance and emphasized profit over good clinical practices throughout its facilities, not just in Massachusetts.

    From 2005 to 2013, 10 clinics owned by UHS in Massachusetts used therapists and other staff that were not licensed for their counseling roles could only do so under supervision.

    Massachusetts has asked for treble damages on the just over $94.2 million in reimbursements it made between 2005 and 2013, as well as civil penalties.

    UHS was not available for comment Tuesday morning but the company has fought back against previous allegations.

    In a Supreme Court ruling on the Escobar case, the high court supported the theory that a company can be held liable if its employees wrongly implicitly certify compliance with all applicable laws and regulations when submitting claims to Medicaid or Medicare.

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