Universal Health Services, Inc. / Turning Point Care Center, LLC
Outcome
Universal Health Services and Turning Point Care Center settled for $122 million for billing for medically unnecessary inpatient behavioral health services, failing to provide adequate care, and paying illegal inducements to federal healthcare beneficiaries.
Details
Universal Health Services / Turning Point Care Center (Moultrie, GA) — $122M Behavioral Health Fraud
Outcome: Universal Health Services and its subsidiary Turning Point Care Center settled for $122 million for billing for medically unnecessary inpatient behavioral health admissions, providing inadequate care, and paying illegal inducements to Medicare and Medicaid beneficiaries.
Universal Health Services, Inc. (UHS), one of the nation's largest for-profit hospital companies, and its subsidiary Turning Point Care Center, LLC of Moultrie, Georgia, resolved a major False Claims Act enforcement action involving three distinct violation types: admitting and billing for inpatient behavioral health services that were not medically necessary; failing to provide adequate and appropriate behavioral health treatment to admitted patients; and paying illegal inducements to federal healthcare beneficiaries to induce enrollment.
The combination of unnecessary admissions, inadequate care delivery, and patient kickbacks reflects a systemic institutional fraud model rather than isolated billing errors. UHS entered into a Corporate Integrity Agreement as part of the $122 million resolution.
The U.S. Attorney's Office for the Middle District of Florida announced the settlement on July 10, 2020.
How Crucible Prevents This
Crucible's inpatient admission necessity controls and anti-kickback enforcement hooks together address this three-pronged violation; a compliance gate requiring documented clinical criteria for every inpatient behavioral health admission, combined with an inducement-audit gate monitoring payments to beneficiaries, would catch all three violation types before they generate $122M in False Claims Act liability.
Don't let this happen to your organization. See how Crucible works.
See How Crucible Works