On May 21, 2014,  Service Employees International Union (SEIU) members delivered letters on behalf of local unions in Massachusetts, Nevada, and Pennsylvania, and UHS workers throughout the country, calling on the UHS Board of Directors to create a qualified committee to oversee quality of care and compliance. Read our letters below:

• UHS Worker Letter from 1199UHE
• UHS Worker Letter from 1107
• UHS Worker Letter from HCPA

We are concerned that UHS facilities are facing multiple government investigations and compliance failures that may place government reimbursements at risk.

Eleven UHS facilities were subpoenaed by the Office of Inspector General, U.S. Department of Health & Human Services in 2013. The U.S. Department of Justice is also conducting a criminal investigation into three UHS facilities in Florida.

UHS facilities have faced regulatory scrutiny resulting in threats of payment suspension or termination from government payment programs, including Southwest Healthcare System and Two Rivers Behavioral Health. Most recently, in April 2014, the Centers for Medicare and Medicaid Services (CMS) instituted a Medicare payment suspension at National Deaf Academy in Florida.

In addition to these investigations, reports issued by state and federal regulators reveal repeated issues related to inadequate staffing, patient security and patient abuse.

Unlike most of the for-profit hospital companies, UHS does not have a dedicated, board-level committee whose primary focus is quality and compliance. Not only does UHS not have a dedicated committee, but when we brought these concerns to their attention, the company said it has “determined that an additional oversight organization is not required.”

With all of the ongoing issues, with all of the investigations, it is simply unacceptable that a company which is the single largest inpatient behavioral health provider in the nation and a major acute care hospital operator believes that there is no need for a dedicated committee on such an important issue.

The Boston Globe recently published a follow-up report on Arbour-HRI/Brookline psychiatric hospital, a subsidiary of Universal Health Services (UHS) –

Three months after state regulators allowed a Brookline psychiatric hospital to start accepting new patients again, federal investigators found deficiencies with psychiatric evaluations and treatment plans, problems they said may have hindered patients’ recovery.

[…]
Frank Barnes, a longtime mental health worker at the hospital and a union representative for 1199SEIU, said the problems at Arbour HRI reflect the culture of the administration.
“The emphasis wasn’t on the quality of care,” he said. “It was on increasing income.’’
Staff members have filed numerous complaints with hospital leaders and regulators about a lack of security personnel; inadequate staff; and patients not having enough towels, blankets, and food at night, he said.

To read the full article click here.

A series of Boston Globe articles reporting on breakdowns in care at Arbour Health System in Massachusetts, a Universal Health Services subsidiary, reveals the human cost of UHS’s failure to prioritize quality of care and compliance throughout the company.

Mental Health Clinics Cited

June 20, 2013 – Arbour Counseling Services –

Dozens of therapists who were unlicensed or improperly supervised routinely treated mentally ill patients at three clinics owned by a major provider of care to low-income people in Massachusetts, state records show.

At an Arbour Health System clinic in Lawrence, state inspectors determined that all 23 therapists were not qualified to see patients on their own, yet were doing so without regular oversight by a licensed professional. Similar staffing violations were discovered at Arbour clinics in Malden and Fall River.

[…]

[Edward] Keohan, the clinic director and a licensed independent clinical social worker, told inspectors that he had been “unaware that supervision was required to be provided on a regular and ongoing basis,” the report said.

To read the full article click here.

Staff Failures Cited in Deaths at Arbour Psychiatric Centers

September 1, 2013 – Arbour-Fuller Hospital, Arbour Hospital, and Arbour-HRI Hospital

[T]hree questionable deaths within 18 months in the Arbour Health System that involved staff failures identified by state or federal health regulators. The health care company, which operates Arbour-Fuller, six other inpatient psychiatric facilities, and a chain of mental health clinics in Massachusetts, has been repeatedly cited for violating patient-care standards before and since the three deaths, including citations for staffing too few nurses or relying too much on lesser-trained or temporary workers.

[…]

At Arbour-HRI, the only Arbour facility with unionized nurses and mental health workers, employees repeatedly have filed complaints with hospital administrators about mandated overtime and low staffing levels at night or on units housing patients who require individual attention. They also have questioned why the hospital has no security staff despite serving patients who can be violent.

Many who work there are trying “to provide a decent standard of care in the face of a corporate philosophy that seems to relentlessly put profits ahead of patient and employee safety,” union spokesman Jeff Hall said by e-mail.

To read the full article click here.

National Reviews of Centers Rare in Mental Health

November 11, 2013 – Arbour Health System

Pennsylvania health officials in 2011 temporarily stopped a mental health center from admitting children or teens after they found poor conditions, excessive use of physical restraints, and too few people caring for patients, according to state records.

In a psychiatric hospital in Chicago the same year, investigators found that violence was “an everyday occurrence,” fueled by understaffing.

And when regulators in North Carolina last year took steps to revoke the license of a residential treatment center after violence at the facility, they cited, among other things, incompetent clinical staff.

All three facilities were owned by Universal Health Services, the largest operator of freestanding psychiatric centers in the United States. Universal has a history of staffing problems at its hospitals around the country, but this record has rarely factored into reviews by state regulators — including in Massachusetts.

To read the full article click here.

New Curb on Brookline Mental Health Hospital

November 26, 2013 – Arbour-HRI Hospital

State regulators have prohibited a Brookline psychiatric hospital from admitting any patients, citing deteriorating conditions and an immediate risk to patient safety.

[…]

Inspectors made a surprise visit to Arbour-HRI in October, after receiving a report about a female patient being forcibly searched, an incident that state Mental Health Commissioner Marcia Fowler described in an interview Monday as “a very serious human rights violation.” The inspectors identified a range of problems, including dirty conditions and untrained or inexperienced staff, she said.

[…]

Fowler was pointed in her criticism of Arbour-HRI officials. The problems inspectors found indicate a “lack of leadership and oversight of that facility,” she said. The first improvement plan was so poor, she said, that it appeared hospital administrators “really seemed to miss the point.”

[…]

The union that represents nurses and mental health workers at the hospital expressed support Monday for the state’s move to freeze admissions.
Jeff Hall, spokesman for Local 1199 of the Service Employees International Union, said members have been telling hospital administrators for years that the facility was understaffed, needed security guards, and lacked the necessary doctors and other medical resources to meet patient needs.

“The appeals by health care workers for improved conditions and staffing at Arbour-HRI have been repeatedly and chronically disregarded by Arbour and its parent company Universal Health Services,” he said in an e-mail.

To read the full article click here.

Brookline Psychiatric Hospital Resumes Taking Patients

December 11, 2013 – Arbour-HRI Hospital

A Brookline psychiatric hospital is again accepting patients, but on a limited basis, after the state gave preliminary approval to the hospital’s plan for correcting serious safety and human rights violations found by inspectors, including the forcible strip-search of a patient.

[…]

The state received several anonymous calls from employees who said they felt “coerced by leadership to be silent about the incident or their jobs would be in jeopardy,” which hospital officials denied, said one inspection report.

[…]

The hospital did not always meet minimum staffing requirements, a situation that made it difficult for nursing staff to respond during patient emergencies, one inspection report said.

To read full article click here.

Regulators Find Brookline Psychiatric Hospital Deficient Again

May 29, 2014 – Arbour-HRI Hospital

Three months after state regulators allowed a Brookline psychiatric hospital to start accepting new patients again, federal investigators found deficiencies with psychiatric evaluations and treatment plans, problems they said may have hindered patients’ recovery.

[…]

Frank Barnes, a longtime mental health worker at the hospital and a union representative for 1199SEIU, said the problems at Arbour HRI reflect the culture of the administration.

“The emphasis wasn’t on the quality of care,” he said. “It was on increasing income.’’

Staff members have filed numerous complaints with hospital leaders and regulators about a lack of security personnel; inadequate staff; and patients not having enough towels, blankets, and food at night, he said.

To read full article click here.

Two UHS facilities are at the center of a scandal that’s rocked the behavioral health system for juveniles in Illinois.

A five-part investigative series launched by the Chicago Tribune in December 2014 found that children in residential treatment centers across the state were being “assaulted, sexually abused and running away by the thousands.”[1]

Two of the most troubled facilities, the Tribune reported, were UHS’s Rock River Academy in Rockford and John Costigan Residential Center in Streamwood.[2]

Most years since 2009, the Tribune reported, “Rock River ranked among the top two Illinois facilities in the rate of dispensing emergency tranquilizers.” The other facility was UHS’s Costigan Center.[3]

UHS closed the Costigan Center in 2013, and the Tribune’s report focused most intensely on Rock River, a 59-bed home for girls with mental health and behavioral issues.[4] The Tribune interviewed 20 former residents of Rock River, who almost uniformly described it as “violent, chaotic and under-resourced.”[5]

The Tribune series motivated state lawmakers to introduce legislation protecting at-risk youths in state care[6] and prompted both of Illinois’ U.S. senators to demand action from federal officials on behalf of institutionalized children.[7]

The Civil Rights Division of the Justice Department also indicated that it was considering action against the facilities identified in the Tribune report.[8] Such action against Rock River would be in addition to another federal investigation that is examining clinical practices at it and 20 other UHS facilities. (Click here for more on that investigation.)

Soon after the Tribune series appeared, Illinois’ Department of Children and Family Services (DCFS) put an intake hold on Rock River and sent monitors to ensure the welfare of its residents.

Then, in late January, UHS officials announced that they were closing Rock River.[9] In announcing the closure, the facility’s administrators said DCFS’s intake hold was unfair and criticized the Tribune’s reporting as “focused on isolated cases and old allegations.”

But the Tribune story about the closure cited recent DCFS data showing that Rock River “remained among the most troubled facilities in Illinois by several key measures of harm to juvenile wards.”

According to the Tribune, “During the five-month period from July 2014 through November, for example, Rock River had the highest rate of youths manually restrained by staff among the 52 residential treatment centers measured by DCFS. The rate of these physical restraints at Rock River was nearly eight times the median for all Illinois facilities.”

As the Tribune noted, “Rock River also had the second-highest rate of self-inflicted wounds by residents and the second-highest rate of wards sent to a psychiatric hospital. In addition, it had the third-highest rate of wards detained by police or charged with crimes, and the fifth-highest rate of alleged aggressive acts by wards.”

But a recitation of statistics doesn’t do justice to the reportage in the investigative series. Following is an excerpt from the Tribune’s December 8 story about a runaway from Rock River who was drawn into prostitution.[10] (Click here for the Tribune’s full “Harsh Treatment” series.)

The central Illinois truck stop was chilly and dark on the November morning last year when Mary Bohanan was arrested for prostitution.

Handcuffed in a Bloomington police squad car, the 19-year-old squirmed in her tight miniskirt and crumpled knee-high boots. Blond-tinted curls fell around her face and dark liner rimmed her tired eyes. It was just after 5 a.m.

As police frisked her pimp, she expressed fear that he might spot her through the squad car window and punish her for getting caught. “I’m scared. … He can see us?” Bohanan asked the arresting officer, according to the police video of the scene.

The young woman offered to truckers for $20 was a juvenile ward of the state who endured a history of abuse before being placed in 2012 at Rock River Academy in Rockford, where officials pledge to keep youths safe and give them a shot at a better life.

Instead she fell into a world of sexual exploitation that seems to be accepted as a fact of life at some of the large residential treatment centers that get millions of taxpayer dollars each year to care for Illinois’ most destitute and troubled young wards, a Tribune investigation found.

The prostitution emerges against a backdrop of violence at the facilities where the threat of sexual coercion is common, residents frequently square off in fights, destroy property, abuse medications and attack peers or staff, government records show.

Teenagers who were prostituted told the Tribune they would run away to escape the turbulence and brutality — then do what survival required on streets where they had no money or life skills. At the facilities, experienced residents introduced others to pimps, escort websites and street corners. Some disappeared into this world and never returned.

Rock River promises close supervision and intensive therapy to youths with behavioral and mental health problems, but state records show that Bohanan was repeatedly attacked by tougher girls — punched in the face, hit with a chair and taunted by a peer who poured a carton of milk on her bed.

“The kids do what they want, and the staff can’t control them,” Bohanan told the Tribune. “To me, it’s like a game to survive. There’s fighting, there’s sexual acts going on with the peers. … Girls come out worse and have more mental problems.”

In public, UHS encourages its employees to report problems to supervisors or through the company’s compliance program. “UHS will not retaliate or tolerate any retaliation against you for reporting in good faith,” says the company’s compliance manual.

Behind closed doors, however, UHS has a history of retaliating against workers who advocate for better patient care. According to lawsuits and reports, UHS workers have been fired for reporting concerns about care to regulators and company management.

The many cases of alleged retaliation at UHS reveal the fundamental flaw with the company’s compliance program. Unlike other investor-owned hospital companies, UHS does not have an independent committee on its board of directors to oversee quality of care concerns and corporate compliance issues.

Without that independent committee, even the most strongly worded compliance manual is in danger of becoming a dead letter. The cases of alleged retaliation summarized below — just a few of the many documented on this website — suggest that there’s a troubling gap between words and deeds in UHS’s compliance program.

“Bruising, Black Eyes and Chokeholds”

In September 2014, NBC News ran a report on disturbing stories of abuse, even death, at UHS’s National Deaf Academy (NDA) in Mt. Dora, Fla.[1] The report featured interviews with two former therapists at NDA, Kyle Gilrain and Carol Savage, who told NBC they “saw bruising, black eyes and chokeholds at the facility in 2012, but they felt pressure from the former CEO to cover it up.”

Gilrain and Savage went ahead anyway and expressed their concerns to both state regulators and management at UHS. They allege that they were fired for doing so. They detailed those allegations in a lawsuit filed in April 2013.[2]

Gilrain said he reported cases of abuse, neglect and overmedication to Florida’s Department of Children and Families (DCF) and to the Agency for Health Care Administration.[3] Then, in September 2012, Gilrain sent an email to the compliance office at UHS detailing multiple cases of unlawful conduct. According to the lawsuit, “Gilrain was terminated from NDA only hours after he sent [that] email to the UHS Corporate Compliance Officer.”

Savage told NBC News things had gotten so bad at NDA that she called a state abuse hotline 12 times in a six-week period. called the abuse hotline 12 times in a six-week period.”)’][4] Eventually, she wrote a letter to UHS President Alan Miller in October 2012 expressing her concerns about care at NDA. Roughly two weeks after sending that letter, Savage was fired.[5]

In their lawsuit, Gilrain and Savage also charge the NDA administration with refusing to report incidents of suspected abuse to the Florida Department of Children and Families and instructing staff to only use corporate UHS forms to document such incidents. As of February 23 2015, Gilrain and Savage’s lawsuit is still ongoing.[6] and NDA is one of the 18 UHS facilities under investigation by federal authorities.

The “Drive By” Therapy Case

Three former therapists at UHS’s Keystone Marion Youth Center in Marion, Va., charged in 2007 that they were fired for refusing to participate in fraudulent billing practices.[7]

Megan Johnson, Leslie Webb, and Kimberly Stafford-Payne charged that UHS “engaged in various activities and techniques” to inflate the reimbursements it received from Medicaid. They alleged that UHS’s Marion facility overbilled for therapy sessions, billed brief interactions as full therapy sessions — what they termed “drive by” therapy — and provoked residents to justify a longer length of stay.

Their lawsuit also accused UHS of charging for therapy sessions provided by an unlicensed, unsupervised therapist, altering records, delaying discharges, and “deliberately understaffing the Youth Center.”[8]

Federal and state authorities joined their false claims whistleblower case, and charged that UHS had engaged in the false billing practices from 2005 to 2010.[9]

In 2012, UHS paid $6.85 million to the government to settle the charges. The workers received an additional undisclosed amount for their employment claims.[10]

Fired for “Being Negative”?

Teresa Weeks worked as a mental health technician at UHS’s Keys of Carolina facility in Charlotte, N.C. In a lawsuit filed in 2011, Weeks alleged that she was fired after reporting patient care concerns to local management and to state officials.[11]

According to Weeks’ lawsuit, “the director of nursing and the facility manager accused [Weeks] of creating power struggles, of being negative, and of being difficult. They also gave the Plaintiff false write-ups in order to create a pretext for firing her.” Although Weeks’ lawsuit was settled confidentially in March 2012, the troubles were not over for UHS.[12]

In August 2012, the facility was cited for serious deficiencies in an inspection by state regulators. According to a local news report, “State officials said conditions in the facility were ‘found to be detrimental to the health and safety of the clients’ and was in the process of revoking the facility’s license.”[13]

UHS officials had begun appealing the action, said the local report, but then they abruptly announced that they would voluntarily close the facility in February 2013.[14] Though now closed, the Keys facility is one of the 18 UHS facilities under inspection by federal officials.[15]

Seeking Real Protections for Caregivers

The above examples suggest that employees seeking to advocate for their patients at UHS facilities are not adequately protected from retaliation when they raise concerns.

UHS needs to create a dedicated committee on its Board of Directors to oversee patient quality of care and compliance with healthcare laws and regulations. This type of committee exists at UHS’s competitors. It’s time that the largest provider of inpatient behavioral health in the country should at least meet, if not exceed, the best practices in the industry.

Unfortunately, even with the ongoing investigations and patient care breakdowns outlined above, UHS CEO Alan Miller has argued that its “Board of Directors has a well-functioning audit committee and, working in conjunction with an extensive quality department, determined that an additional oversight organization is not required.”[16]

Over the last decade, Universal Health Services has transformed itself. Ten years ago, it would have been accurate to call UHS a for-profit chain of acute care hospitals with a sideline in the behavioral health business.[1]

But today the behavioral division generates roughly three-quarters of the company’s profits.[2] And after a series of acquisitions, UHS is now four times larger than the next biggest owner of freestanding behavioral hospitals.[3]

Why has UHS made such an aggressive move into behavioral services?

Chief Financial Officer Steve Filton offered one key reason during a presentation to investors in 2013. The behavioral sector, he said, “tends to get, I don’t want to say no attention, but a fairly minimal amount of attention from payers, which I think is generally a good thing.”[4]

With that perceived lack of scrutiny, UHS has been aggressively growing its behavioral business — and growing the business’ profit margins.[5] In 2013, about one in every four dollars generated by UHS’s behavioral division went into profit, not patient care.[6] That’s five times the profit margin of its acute care business.[7]

Maximizing Profits, Minimizing Responsibility

UHS executives have told investors that the company boosts its profits by reducing staffing costs[8] and keeping occupancy rates high.[9] But cutting staff too low can be dangerous for patients and workers.

When things do go wrong at UHS-owned facilities, the company has a troubling tendency to minimize its responsibility.

In September 2014, NBC News aired disturbing stories of abuse, and even death, at UHS’s National Deaf Academy (NDA) in Mt. Dora, Fla.[10] One family said their 10-year-old autistic son was punched, possibly molested and ultimately “broken” at NDA. Another family told of pulling their child out of the facility in 2013 when they saw bruises and other signs of physical abuse.

Asked for comment, UHS issued a statement to NBC saying NDA was “independently operated,” though “expected to meet the highest standards of patient care.

During a regulatory dispute in Virginia in late 2014, UHS executive Dean Montgomery tried to minimize the importance of the ongoing federal probe into 18 of UHS’s behavioral facilities around the country. Montgomery argued that the company’s application to expand a local facility should not be affected by the federal probe, since many of the facilities under investigation “are ones that UHS acquired from prior owner/operators.”[11]

What Montgomery neglected to say is that UHS bought those facilities four years earlier, back in 2010, and many alleged incidents of abuse and neglect occurred well after UHS took them over from Psychiatric Solutions Inc. (PSI).

Ironically, a year before Montgomery was evading blame for the failings of those former PSI facilities, UHS CFO Filton was taking credit for their improved profit margins. Speaking at 2013 investor conference, Filton said of the PSI facilities, “When we bought them…their operating margins were slightly below UHS’s.… I think they are now, after two years operating really at par.”[12]

Unwelcome Attention

The federal investigation into UHS suggests that the “minimal amount of attention” it once enjoyed may be coming to an end.

UHS is still making plans for aggressive growth. In 2014, Filton said UHS’s behavioral division intends to maintain a “600, 650-bed a year expansion pace, at least through 2015 and 2016.”[13]

But those plans may prove hard to sustain if what is now a federal probe leads to formal federal charges.

There’s a new measure of excellence for America’s acute care hospitals — and no UHS hospital received a top ranking.

On April 16, the Center for Medicare and Medicaid Services launched a 5 star ranking system at its Hospital Compare website. It includes a ranking from 1 star (the worst) to 5 stars (the best) for 3,553 U.S. hospitals.

No UHS hospital received 5 stars. And in Las Vegas, which has been a very profitable market for the company, all five UHS hospitals got just 2 stars. That puts them in the bottom 18 percent of American hospitals.

An article in Becker’s Hospital Review, noted that 3 percent of U.S. hospitals received 1 star and 15 percent of hospitals received 2 stars.

UHS has 21 acute care hospitals that were ranked and only one UHS hospital got 4 stars. (Behavioral facilities are not included in the Hospital Compare rankings.)

Go to Becker’s Hospital Review here to read more about the new ranking system.

(UPDATED) A troubled UHS behavioral facility in North Carolina that’s looking to add 60 beds got a less than rousing reception at a public hearing on its expansion plan.

UHS’s Old Vineyard Behavioral Health Services in Winston-Salem is looking to build a $14 million addition by 2017. But opponents of the plan — including a healthcare advocate from UHS Behind Closed Doors — were on hand at Monday’s hearing to raise key questions about the facility.

Old Vineyard is one of the 21 UHS behavioral facilities under investigation by the U.S. Justice Department for possibly illegal clinical practices.

“UHS is the nation’s biggest behavioral health provider, so they set the standards for quality,” UHS Behind Closed Doors healthcare advocate Aneeb Sharif told the Winston-Salem Journal. “Unfortunately, those standards are unacceptably low.”

According to the Winston-Salem Journal, a local opponent of the facility, Laurie Coker, said, “We’re violating the public’s trust if these beds are permitted and not properly used.”

State and federal regulators have found numerous problems with the existing facility. As Sharif noted in his remarks, “Health inspection reports dating back to at least 2009 reveal incidents of sexual assault and other egregious violations tied to inadequate staffing.”

Even the supporters of Old Vineyard’s expansion plan sounded less than enthused about it. According to the Winston-Salem Journal, “As speakers lent their support, they also stressed to state regulators…that they expect a higher level of quality for services if the expansion is granted.”

Perhaps the biggest drawback with the UHS expansion is that it appears unlikely to add any new psychiatric beds in North Carolina. As the Journal reported, Old Vineyard “would gain the beds from Broughton Hospital, a state hospital in Morganton.”

Click here for the full story on the hearing from the Winston-Salem Journal. The paper also wrote a preview piece about the hearing here.

UPDATE: The Winston Watchman, an indispensable local blog, has posted an article opposing the Old Vineyard expansion.

Congressman Joe Kennedy III just took a strong stand for everyone fighting to improve mental health care in America.

This week, Kennedy called for “swift action” in the federal investigation of potentially illegal clinical practices at Universal Health Services (UHS), the biggest behavioral health provider in America.

Rep. Kennedy — joined by Rep. Danny Davis of Illinois — sent a letter to the top official of Medicare and Medicaid expressing “serious concerns about the welfare of patients” at UHS’s behavioral facilities. (UHS got over $4 billion last year from Medicare and Medicaid.)

Rep. Kennedy’s district includes Arbour-HRI, one of 21 UHS behavioral facilities under investigation by federal officials. As his letter noted, Arbour-HRI is part of a UHS health system that’s been cited for “staffing failures, ‘cutting corners,’ negligent care, and even patient deaths” by the Boston Globe.

The word about UHS is definitely getting out. The Dallas Morning News just ran a powerful story about a tragic suicide and other serious breakdowns in care at UHS’s Timberlawn psychiatric hospital in Texas. The story cited UHS Behind Closed Doors team member Ryan Pfeffer noting these “issues are not uncommon” at UHS facilities.

For too long, UHS’s troubled mental health facilities had been able to keep a low profile. But thanks to the work of Reps. Kennedy and Davis — and to the 11,000 signers of our petition to UHS — we’re putting a spotlight on the problems at the for-profit healthcare chain.

§  Read coverage of the Kennedy-Davis letter in Modern Healthcare and the Chicago Tribune.

§  Read the media advisory from Rep. Kennedy’s office. And the full text of the letter from Reps. Kennedy and Davis is below.

June 23, 2015

Andy Slavitt
Acting Administrator
Center for Medicare and Medicaid Services
Department of Health and Human Services
Hubert H. Humphrey Building, Room 445-G
200 Independence Avenue, SW
Washington, DC 20201

Dear Acting Administrator Slavitt:

We are writing regarding the ongoing investigations into Universal Health Services (UHS), a for­ profit hospital management company with over 200 behavioral health facilities located throughout the U.S. Recent news reports have highlighted alarming incidences of mismanagement and negligence raising questions about the company’s ability to provide quality care to Medicare and Medicaid beneficiaries.

As you may be aware, there are ongoing federal investigations at 21 UHS-owned facilities, and recently, the U.S. Department of Justice (DOJ) Criminal Frauds Section began an investigation of the parent company. In addition to criminal fraud investigations of UHS corporate and three facilities in Florida, there is an ongoing False Claims Act investigation by the DOJ Civil Division and the Department of Health and Human Services’ Office of the Inspector General of 18 additional UHS facilities. We are deeply concerned about this expanding federal probe not only because UHS facilities operate in our districts but because UHS is the nation’s largest provider of inpatient behavioral health services, operating one in five inpatient mental health beds[1] with $4.3 billion of Medicare and Medicaid revenue in 2014.[2]

Media and press reports point toward a troubling number of quality of care and patient safety failures at UHS-owned facilities. The Boston Globe published a series of articles in 2013 and 2014 citing staffing failures, “cutting corners,” negligent care, and even patient deaths across Arbour Health System facilities in Massachusetts.[3] Particularly problematic was Arbour HRI, a UHS psychiatric hospital in Brookline that federal investigators have cited for clinical deficiencies that may have hindered patients’ recoveries.[4] In addition to UHS corporate, DOJ is investigating three facilities in Florida, including Wekiva Springs Center, River Point Behavioral Health, and National Deaf Academy.

In December 2014, The Chicago Tribune in conjunction with Northwestern University’s Medill Watchdog published a series of articles detailing violence, sexual assaults, patient runaways, and lack of security staff at Rock River Academy in Illinois, Foundations for Living in Ohio, and other facilities. As a result of these alarming stories, the Illinois Department of Children and Families placed Rock River Academy under an intake hold and enhanced monitoring. This facility, which UHS has chosen to close, is currently under federal investigation.

We also are concerned by reports of retaliation against employees who expose problems at UHS facilities. A 2011 report by the University of Illinois at Chicago (UIC) on Hartgrove Hospital concluded that “Hartgrove staff were reportedly told by UHS officials (parent company) that anyone suspected of providing information to the UIC reviewers would be fired.”[5]

Given the serious allegations of fraud, negligence, and staff retaliation, we have serious concerns about the welfare of patients. We respectfully request an update regarding HHS’ investigation and additional information on any actions that CMS or HHS plan to take in response to the grave allegations against UHS.

Thank you in advance for your attention and cooperation with our request. We look forward to hearing more from you on this matter.

Sincerely,

Joseph P. Kennedy III, Member of Congress                 Danny Davis, Member of Congress

Go to the website of UHS’s Sun Coast Behavioral Health Center and you’ll find soothing pictures of smiling children and beaming adults.

On its homepage, the Bradenton, Fla., psychiatric facility says, “We pride ourselves on providing the highest level of healthcare services to our patients.” But dig a little deeper and a very different picture of Sun Coast emerges.

If you look at the percentage of revenues that Sun Coast devotes to staff compensation, it has the lowest level of spending of any comparable facility in Florida.

Among all short-term psychiatric hospitals in Florida, median spending on staff salaries, wages and benefits is 45.2 percent of revenues. But Sun Coast devotes just 26.7 percent of its revenue to staff compensation.[1]

Sun Coast is joined at the bottom of the barrel by two other UHS hospitals, which devote a smaller share of revenues to staff than any other Florida facilities:

• UHS’s Wekiva Springs Center in Jacksonville spent just 30.8% of revenue on staff pay & benefits in 2013.
• UHS’s River Point Behavioral Health, also in Jacksonville, spent just 32.8% of revenue on staff compensation.

Wekiva Springs and River Point have earned another dubious distinction. Both of them are being investigated by the U.S. Department of Justice’s Criminal Fraud Section.

Unfortunately, these three facilities are not an aberration in UHS’s Florida operations. Altogether, median spending on staff by UHS’s short-term psychiatric facilities is just 40.3 percent of their revenues; roughly five percentage points below the state median.

One has to wonder how UHS can provide “the highest level of healthcare services” to patients when it’s spending so little on the staff that provide that care.

The nation’s largest provider of inpatient behavioral health services and current focus of United States federal law enforcement criminal fraud investigators, Universal Health Services, Inc. (UHS), was forced to walk away from a proposed facility in Rocklin, CA following vocal community opposition over the proposed location.[1]

ROCKLIN, CA.–On January 14, 2016, the City of Rocklin confirmed[2] troubled for-profit behavioral health provider UHS has backed away from a controversial proposal to build a new facility located next to a senior living complex,  600 feet from Whitney High School, and half a mile from a community park.[3] [4]

Local residents and community activists first raised safety and security concerns about the location of the proposed facility last fall.[5] Since then, local community members and healthcare activists- including the Concerned Families of the Greater Whitney Ranch Area and the UHS Behind Closed Doors project- have uncovered numerous safety and security deficiencies at UHS facilities and worked to educate community leaders and stakeholders of their findings. These concerns were further exacerbated after the local school board, the police chief, and Rocklin city staff, all conducted analyses of their own and raised concerns about the proposal.[6] [7] 

The Rocklin District School Board voted unanimously to oppose UHS’ proposal, reportedly due to “serious safety concerns about the proposed hospital…without compelling arguments to the contrary,” after they contracted a study that found UHS provided “vague blanket statements about security measures.”[8] 

The Rocklin Police Chief also conducted his own public safety impact report by requesting information from other law enforcement jurisdictions in which UHS has facilities.[9]  The Police Chief’s report noted seven areas of concern with the proposal, including concerns related to patient discharge and proximity of the project to the local high school.[10] 

Ultimately, Rocklin city staff recommended denial of the proposal because of the “insufficient separation from existing schools” and determined that the proposal could be “detrimental to the health, safety, or general welfare of persons residing or working in the neighborhood of the proposed use.”[11] 

In public meetings about the proposal, community members and local activists learned more about the problems facing the corporate parent, UHS, and their facilities across the country. In fact, UHS is facing a criminal fraud investigation and 21 facilities have been subpoenaed in related investigations since February 2013.[12]   Additionally, in many communities, UHS has failed to adequately staff facilities[13] and provide adequate security and training, [14]  often leading to patient escapes, injuries, and deaths.

Thursday, March 3, 2016

Contact:  Meghan Finegan: Meghan.Finegan@seiu.org c: 617-283-8597

Bazelon Center for Mental Health Law, Mental Health America, SEIU File Joint Amici Brief

Washington, DC —The Service Employees International Union (SEIU), joined by nationally recognized mental health advocates, Mental Health America and the Judge David L. Bazelon Center for Mental Health Law, filed an amici curiae brief today in the Supreme Court of the United States in support of a patient’s family in Universal Health Services, Inc. v. United States ex rel. Escobar. The family seeks to hold Universal Health Services (UHS) accountable under the False Claims Act (FCA) for claiming Medicaid payments even though UHS’s care failed to meet minimum licensure and supervision requirements for mental health services.  The family’s teenage daughter tragically passed away while under the care of unlicensed and unsupervised staff at a UHS facility in Massachusetts.

The brief clearly shows UHS’s record of violating patient-care requirements throughout the country and demonstrates how vibrant whistleblower tools and claims like the one brought by the family play an important role in protecting patients.

“If we commit to taking action before mental illnesses reach Stage 4, then the moment that brings a family into contact with a health care provider is a critical moment for intervention,” said Paul Gionfriddo, President and CEO of Mental Health America.  Gionfriddo continued, “And if we don’t provide families and individuals with quality care at that time, then we’ve failed them. And that is something we can’t afford to do, if we’re serious about treating mental illnesses the same as we treat other serious health conditions.”

Yarushka Rivera was a 17-year-old girl living with a psychiatric disability who sought care at a UHS facility. The teen was treated by unlicensed and inadequately supervised staff. UHS’s staff prescribed a medication for Ms. Rivera that allegedly led her to develop seizures and she died a few months later of a seizure. UHS then billed the Massachusetts Medicaid program for the girl’s care. Upon investigation of these events, the state’s Department of Public Health and Division of Licensure confirmed  that care was provided by unsupervised staff in violation of state law.

Ms. Rivera’s family filed a False Claims Act case in federal court in July 2011 and filed a second amended complaint in February 2013. The federal District Court dismissed the case in its entirety in March of 2014—ruling that the regulations allegedly violated by UHS were not “conditions of payment,” which the court deemed to be a pre-requisite to FCA liability.

The family then appealed the dismissal to the U.S. First Circuit Court of Appeals and in March 2015 that court reversed the dismissal—ruling that compliance with staff supervision and core staffing requirements are a condition of payment by the Massachusetts Medicaid program, MassHealth.

The False Claims Act is one of the country’s most effective tools in combating fraud. In 2015 alone, the Department of Justice recovered more than $3.5 billion in settlements and judgments from FCA cases.

In addition, most false claims actions are filed under the FCA’s whistleblower provisions, which allow individuals to file on behalf on the government. The government has the right to intervene in these actions; if the government declines to intervene, the individual may proceed alone.

UHS seeks to limit potential liability under the FCA, which could have a chilling effect for future whistleblowers and for the quality of health care delivered in any setting. UHS is making hundreds of millions of dollars in profits while its facilities routinely violate state and federal rules designed to protect mental health patients.

“It is appalling that a company with such a disturbing track record of care would be pushing for the Supreme Court to rewrite the law to silence patients, families, and care providers in the reporting of any potential fraud in our healthcare system,” said Leslie Frane, Division Director, SEIU Healthcare.

The date for oral arguments in this case has not been set yet by the Court.

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SEIU Healthcare is the healthcare arm of SEIU, representing 1 million members who work in healthcare and mental health settings. SEIU Healthcare members work in UHS facilities across the country and are dedicated to protecting patients and improving quality of care.

Read the summary of SEIU’s amicus brief.

Get the facts about UHS practices impacting mental health patients and their families.

Read this press release on SEIU.org.

Contact:
Ryan Pfeffer, Ryan.Pfeffer@seiu.org, 614-270-9474

Issued April 18, 2016

Arguing Before the Supreme Court, the US Solicitor General Makes the Case for Preserving Critical Whistleblower Tools to Hold Providers Like Universal Health Services Accountable for Breaking the Law

Washington, DC —The U.S. Solicitor General and attorneys for a whistleblowing family argue before the Supreme Court of the United States in Universal Health Services, Inc. v. United States ex rel. Escobar on April 19 to preserve a valuable tool for holding law-breaking healthcare providers accountable. The Service Employees International Union (SEIU), joined by nationally recognized mental health advocates, Mental Health America and the Judge David L. Bazelon Center for Mental Health Law, filed an amici curiae brief in support of the family.

The family seeks to hold Universal Health Services (UHS) accountable under the False Claims Act (FCA) for claiming Medicaid payments even though UHS’s care failed to meet minimum licensure and supervision requirements for mental health services. The family’s teenage daughter tragically passed away while under the care of unlicensed and unsupervised staff at a UHS facility in Massachusetts. UHS is the largest provider of behavioral health services in the country, operating 1 out of every 5 psychiatric beds nationally, and is the subject of an ongoing federal fraud investigation involving at least 25 facilities. The underlying allegations and the briefs submitted in support of the family show UHS’s record of violating patient-care requirements throughout the country and demonstrate how vibrant whistleblower tools and claims like the one brought by the family play an important role in protecting patients.

Yarushka Rivera was a 17-year-old girl living with a psychiatric disability who sought care at a UHS facility. The teen was treated by unlicensed and inadequately supervised staff. UHS’s staff prescribed a medication for Ms. Rivera that allegedly led her to develop seizures and she died a few months later of a seizure. UHS then billed the Massachusetts Medicaid program for the girl’s care. Upon investigation of these events, the state’s Department of Public Health and Division of Licensure confirmed that care was provided by unsupervised staff in violation of state law.

“If we commit to taking action before mental illnesses reach Stage 4, then the moment that brings a family into contact with a health care provider is a critical moment for intervention,” said Paul Gionfriddo, President and CEO of Mental Health America. Gionfriddo continued, “And if we don’t provide families and individuals with quality care at that time, then we’ve failed them. And that is something we can’t afford to do, if we’re serious about treating mental illnesses the same as we treat other serious health conditions.”

UHS seeks to limit potential liability under the FCA, which could reduce the scrutiny of their operations and have a chilling effect on future whistleblowers. UHS is making hundreds of millions of dollars in profits while its facilities violate state and federal rules designed to protect mental health patients.

“It is appalling that a company with such a disturbing track record of care would be pushing for the Supreme Court to rewrite the law to silence patients, families, and care providers in the reporting of any potential fraud in our healthcare system,” said Leslie Frane, Division Director, SEIU Healthcare.

A decision by the Court is expected this summer.

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SEIU Healthcare is the healthcare arm of SEIU, representing 1 million members who work in healthcare and mental health settings. SEIU Healthcare members work in UHS facilities across the country and are dedicated to protecting patients and improving quality of care.

Read the summary of SEIU’s amici brief.

Get the facts about UHS practices impacting mental health patients and their families.

Contact:
Tracy Honhart, Tracy.Honhart@seiu.org, 510-343-8625

Issued May 16, 2016

On May 18th, Universal Health Services, Inc. (UHS), the largest provider of behavioral healthcare services with 1 out of every 5 psychiatric beds nationally, will be holding its annual meeting for shareholders. Shareholders should be aware of their exposure to risk from an expanding federal investigation and abundance of patient care breakdowns at UHS facilities across the country.

Specifically, UHS finds itself under a Department of Justice (DOJ) criminal and civil fraud investigation involving the corporation and 25 of its facilities, plus a separate DOJ Stark Law investigation at a facility in El Paso, TX and another separate federal investigation of UHS physician contracts at its South Texas Health System. However, previous efforts by shareholders and patient advocates to improve accountability have been blocked, by an insular board of directors controlled by CEO Alan Miller. Miller controls over 80% of the voting power and elects five of the seven directors on the board despite owning less than 15% of the shares.

UHS’s board and management recently pushed to limit accountability even further when they escalated one of its patient death cases, Universal Health Services v. United States ex rel. Escobar (“Escobar”), to the U.S. Supreme Court. Escobar highlights an especially troubling example of UHS’s poor patient care on a national stage. The Escobar family’s teenage daughter tragically passed away while under the care of unlicensed and unsupervised staff at a UHS facility in Massachusetts, in violation of state law. The family seeks to hold UHS accountable under the False Claims Act (FCA) for claiming Medicaid payments even though UHS’s care failed to meet minimum licensure and supervision requirements.

As UHS argues for significant whistleblower restrictions, many of its facilities have violated state and federal laws designed to protect behavioral health patients and caregivers while the company reaps millions of dollars in profit. In fact, it was recently disclosed that in the last three years, 44 of UHS’s facilities had findings of “substantial non-compliance” due to serious deficiencies in quality and faced possible termination from Medicaid and Medicare. During oral arguments in this case, Justices Sotomayor and Kagan grilled UHS about their conduct, with Justice Sotomayor stating that, “I’m having a hard time understanding how you have not committed a fraud if you knew what you were doing.”

In addition to the U.S. government, large institutional investors have taken serious notice of UHS’ careless lack of board accountability and have proposed a resolution aimed at giving shareholders a meaningful voice in board elections by enabling shareholders to place their nominees for director on a company’s proxy card. The New York City Pension Fund and the California Public Employees’ Retirement System, two of the largest public pension funds in the country, have already publicly voiced support for the proposal and note that access is a “fundamental shareholder right” and would provide “accountability in the boardroom.”

UHS’s board and management have made decision after decision that have exposed this company, shareholders, and communities to tremendous risk. Improving shareholders’ voice by allowing access to the proxy will be essential to increasing boardroom accountability over this tightly controlled company.

UHSBehindClosedDoors.org is bringing to light serious problems in care at Universal Health Services, the nation’s largest provider of behavioral health care. It is an online resource for mental health advocates and caregivers supported by the Service Employees International Union.

Contact: Ryan Pfeffer, Ryan.Pfeffer@seiu.org, 614-270-9474; Issued June 16, 2016

The Supreme Court’s ruling today in Universal Health Services v. United States ex rel. Escobar preserves the ability of whistleblowers to bring claims under the False Claims Act (FCA) when government contractors, like Universal Health Services (UHS), lie by omission. Affirming the “implied false certification” theory of liability, the Court held that contractors can be liable when they bill the government for services while knowingly failing to disclose violations of statutory, regulatory, or contractual requirements that would be material to the government’s decision about whether to pay those claims.

This case involves the tragic death of a teenage girl, Yarushka Rivera, while seeking mental health treatment from a UHS subsidiary in Massachusetts. The teen was allegedly treated by several unlicensed and unsupervised staff, including a nurse who held herself out as a psychiatrist and another staff member who claimed to be a psychologist despite having had her licensing application rejected by the state licensing authority. Yarushka’s parents filed suit as relators under the FCA after her death. They claim that UHS billed the Massachusetts Medicaid program for Yarushka’s care even though it was provided by unlicensed and inadequately supervised staff in violation of state law, and used billing codes and job title codes suggesting that the care had been performed by properly licensed and supervised caregivers.

Justice Thomas, writing for a unanimous court, explained that “by submitting claims for payment using payment codes that corresponded to specific counseling services” without disclosing UHS’s “many violations of basic staff and licensing requirements for mental health facilities, Universal Health’s claims constituted misrepresentations.”

SEIU Executive Vice President Leslie Frane said, “The Supreme Court’s unanimous block of industry attempts to limit fraud liability is critically important and a great victory for healthcare workers and patients who bravely step forward to blow the whistle on companies that break the law.” In partnership with The Judge David L. Bazelon Center for Mental Health Law and Mental Health America, SEIU submitted an amici curiae brief in support of the Relators which explained that this case was not an isolated incident, and advocated for the whistleblowers and patients who benefit from the FCA.

UHS is the largest provider of inpatient behavioral health care in the country, operating 1 out of every 5 psychiatric beds in the United States. The company owns almost 200 of the estimated 500 total freestanding behavioral health hospitals in the U.S.

In addition to the issues of unqualified and unsupervised staff raised in this fraud case, the company finds itself mired in three separate federal fraud investigations. In March of 2015, Universal Health Services revealed that it is under investigation as “a corporate entity” by the U.S. Department of Justice Criminal Fraud Section. Modern Healthcare reported that it is a “criminal investigation into whether the company fraudulently billed Medicare and Medicaid for behavioral health treatments.” Three of UHS’s behavioral facilities had already been under criminal investigation. One of those facilities — River Point Behavioral Health in Jacksonville, Fla. — has had its payments suspended by Medicare and Medicaid since April 2014. UHS and 25 of its behavioral health facilities are also the subject of a coordinated civil investigation by federal authorities.  In February of 2015, UHS disclosed that the civil aspect of the coordinated probe is a False Claims Act investigation focused on billings submitted to the government.

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SEIU Healthcare is the healthcare arm of SEIU, representing 1 million members who work in healthcare and mental health settings. SEIU Healthcare members work in UHS facilities across the country and are dedicated to protecting patients and improving quality of care.

To learn more about our ongoing concerns about UHS, please visit: http://uhsbehindcloseddoors.org/

Get the facts about UHS practices impacting mental health patients and their families.

The Dallas Morning News’ Miles Moffeit takes a sobering look at whether healthcare regulations are strong enough to protect patients and staff at Timberlawn Mental Health System—a UHS-operated behavioral health facility in Dallas, TX, with a “lengthy history of regulatory trouble.”

The article notes:

“Two months after a violent patient killed a doctor at Timberlawn  — and nine months after Texas officials moved to close the hospital over unsafe conditions — the facility remains open.

And its Pennsylvania owners haven’t paid a cent of the $1 million fine the state levied in December.”

The article explains that the system in place tasked with regulating health care facilities is not the most effective:

“Texas law gives health-care providers substantial wiggle room to fight penalties as they continue to operate. Hospitals can take months to bargain down fines or respond to efforts to revoke their licenses.”

“Texas health officials acknowledge they don’t focus on punitive actions. Instead of lowering the boom on hospitals for safety breaches, they say they try to nudge the facilities into fixing problems. But under that system, some hospitals appear to operate with impunity for years, undermining the enforcement process, critics say.”

 

Read the Dallas Morning News Story: “Is Texas too easy on troubled Dallas psychiatric hospital?”

Read the March 2016 Dallas Morning News investigation into the shocking number of serious safety violations at dozens of UHS hospitals, including Timberlawn:  “Danger in the psych ward: Safety issues plague a chain of mental-health hospitals in Texas and across the United States.”

Buzzfeed News’ Rosalind Adams takes a sobering look at the questionable practices and breakdowns in care at facilities operated by the nation’s largest provider of psychiatric services, Universal Health Services, Inc. (UHS).

The article notes:

“A yearlong BuzzFeed News investigation — based on interviews with 175 current and former UHS staff, including 18 executives who ran UHS hospitals; more than 120 additional interviews with patients, government investigators, and other experts; and a cache of internal documents — raises grave questions about the extent to which those profits were achieved at the expense of patients.”

“Current and former employees from at least 10 UHS hospitals in nine states said they were under pressure to fill beds by almost any method — which sometimes meant exaggerating people’s symptoms or twisting their words to make them seem suicidal — and to hold them until their insurance payments ran out.”

The article further revealed:

“Several people who ran UHS hospitals said corporate bosses pushed them to cut their hospitals’ staff further and further each year, regardless of the impact on employees’ safety or on their ability to care for the people being admitted.

Each year, hospital administrators presented their budgets to a panel of corporate leaders. And each year, people who were involved with the process say, corporate execs offered the same prescription: Cut more staff.”

Read the Buzzfeed investigation, which includes stories from former patients and workers here.

The Oregon Health Authority (OHA) has turned down Universal Health Services, Inc (UHS) and its NEWCO subsidiary’s request to build a 100-bed psychiatric hospital in Wilsonville. In the OHA’s proposed decision to deny UHS’ application, the “OHA found that NEWCO met only one of eight criteria” required to gain approval for its proposed hospital.

The Oregonian reports that this “marks just the second time in 27 years that state officials have denied a request to build a new hospital… The Oregon Health Authority approves most applications with little fanfare. But Universal’s Wilsonville plan drew opposition from mental health advocates, organized labor and competing healthcare companies.”

The Oregonian also reports that activists have raised concerns that UHS’ proposed hospital “is the wrong plan in the wrong place from the wrong company.” Some of these concerns stem from the fact that:

“The federal government has since 2013 been investigating possible fraudulent billing practices at as many as 23 Universal hospitals. Plus, the company has been nagged by repeated questions about patient safety and other quality issues.”  

The Oregonian also  notes that:

“Last March, Texas officials asked Timberlawn Mental Health System in Dallas to surrender its license and pay a record $1 million fine. In December, news website Buzzfeed issued a harrowing account of life inside Universal hospitals. Based on a reported 175 interviews with former patients and employees, the article accused Universal of systematically holding patients who did not pose a danger to themselves against their will until their insurance coverage ran out.”

UHS is challenging the proposed decision and has requested that an informal hearing be held before a final OHA decision is rendered.

Read the OHA’s proposed decision here.