Massachusetts sues UHS in Medicaid false claims case and other regional news

The state of Massachusetts sued Universal Health Services in federal court last week, accusing it of illegally charging Medicaid for outpatient mental health services by unqualified staff.

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. UHS is accused of propagating a culture of noncompliance that emphasized profit over good clinical practices throughout its facilities, not just in Massachusetts. Earlier this year, a Buzzfeed investigation alleged the for-profit hospital operator kept psychiatric patients longer than necessary to milk their insurance.

UHS did not respond to a request for comment, but the company has fought back against previous allegations.

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

—Modern Healthcare

The Pennsylvania Senate has introduced legislation that would allow nurse practitioners to practice without the supervision of a physician.

The bill, which is currently before the Senate Consumer Protection and Professional Licensure Committee, is designed to help ease the shortage of healthcare providers in rural and underserved areas of the state by easing restrictions on nurse practitioner supervision. But physicians opposed to the legislation claim nurses don't have the training to provide care on their own.

Under current Pennsylvania law, nurse practitioners work alongside physicians in practices as part of a collaborative agreement.

The proposed legislation would allow nurse practitioners to provide care independent of a physician after they complete a three-year, 3,600-hour collaboration agreement with a physician. The nurse can practice independently within the clinical specialty area they received their license in.

About 35% of Pennsylvania residents live in an area with inadequate access to primary care, said GOP state Sen. Camera Bartolotta, who introduced the bill.

"Many rural communities suffer from a severe lack of healthcare access, forcing many patients to travel an hour or more for care," he said. "Expanding the practice authority of (nurse practitioners) is a logical step to help break down the barriers to quality healthcare services."

The Pennsylvania State Nurses Association supports the legislation.

But the Pennsylvania Medical Society, which represents 16,000 physicians and medical students in the state, opposes the bill and says eliminating the collaborative relationship between physicians and nurses will "fragment patient care and jeopardize patient safety."

—Maria Castellucci

Norton Healthcare and the University of Louisville in Kentucky have created the Norton Children's Cancer Institute to combine the university's research and advanced clinical trials with Norton's cancer care.

The agreement announced last week formalizes a relationship that's been around for decades, said Dr. Charles Woods, interim chairman of the university's department of pediatrics.

The university and Norton, a five-hospital system based in Louisville, are building their relations just as the University of Louisville Hospital is dissolving its joint operating agreement with Norton's crosstown rival, KentuckyOne Health.

The new children's cancer institute is forming joint committees to provide improved access and additional services for children fighting cancer, Woods said. The institute also plans to revamp a bone marrow transplant program, he said.

The university and KentuckyOne announced in December that they are terminating a troubled joint operating agreement that has seen KentuckyOne manage the academic medical center and the accompanying James Graham Brown Cancer Center for the past four years. The agreement is scheduled to dissolve on July 1, at which time management of the hospital and the cancer center will revert back to University Medical Center, said hospital spokesman Gary Mans.

—Dave Barkholz