Meghan Finegan, Meghan.Finegan@seiu.org, 617-283-8597
Issued March 03, 2016
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.
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.