DOJ expands criminal fraud investigation to Universal Health Services headquarters

Hospitals owned by Universal Health Services have faced false claims scrutiny since February 2013, but criminal investigators have recently turned their attention to UHS corporate offices, located in King of Prussia, Pennsylvania, according to a Securities and Exchange Commission (SEC) disclosure filed by the company last week.

In March 2015, federal authorities alerted UHS that the criminal investigation into various UHS-owned hospitals had expanded to include UHS as a corporate entity. Specifically, investigations into Hartgrove Hospital in Chicago led investigators to turn their attention toward the company's headquarters, according to the disclosure.

UHS hospitals, which specialize in mental health treatment, including depression and addiction, have faced false claims scrutiny for the past several years. In Febraury 2013, the Office of Inspector General (OIG) issued subpoenas to 10 UHS-owned hospitals, requesting documents dating back to 2008. Later that year, UHS received notice that the Department of Justice's (DOJ) Civil Division had referred two investigations of two behavioral health hospitals to the criminal division. In April 2014, CMS suspended payments to one of those facilities, River Point Behavioral Health in Jacksonville, Florida.

The investigation reflects a new approach by the DOJ, in which civil and criminal divisions work in conjunction with one another to investigate false claims cases, FierceHealthPayer: AntiFraud previously reported. Both civil and criminal investigations at various UHS facilities continued throughout 2014.

In February and March 2014, UHS was notified of ongoing civil and criminal investigations involving the National Deaf Academy. Civil Investigative Demands were also served in four other hospitals in March, including Hartgrove Hospital. In September 2014, the DOJ expanded that investigation, adding four additional hospitals to the probe. In March, OIG also issued subpoenas to two other UHS-owned behavioral health hospitals in Florida.

"At present, we are uncertain as to potential liability and/or financial exposure of the Company and/or named facilities, if any, in connection with these matters," the company stated in the disclosure.

This marks the second time in six weeks that fraud and false claims investigations have been made public through SEC filings. In February, Humana revealed a widespread federal probe into Medicare Advantage plans and potential overbilling tied to risk scores, FierceHealthPayer: AntiFraud previously reported.

Behavioral health providers have been frequent targets of state and federal investigations, leading to overzealous scrutiny in some cases. Recently, a botched audit led New Mexico to cut off Medicaid funding to 15 behavioral health providers.

For more:
- here's the SEC disclosure