The governments of the United States and Massachusetts appear poised to intervene in a closely watched False Claims Act case in which two whistleblower plaintiffs accuse Universal Health Services of using unlicensed and unqualified therapists in its facilities, resulting in the submission of false claims to Medicaid.
Julio Escobar and Carmen Correa filed the suit against the hospital management company under the whistleblower provisions of the False Claims Act, which permits private parties to sue on behalf of the federal government.
They brought the lawsuit after Yarushka Rivera, Ms. Correa’s daughter and Mr. Escobar’s step-daughter, died of an adverse reaction to medication she was given at UHS’ mental health center in Lawrence, Massachusetts, to treat her bipolar disorder. According to the complaint, Yarushka, 17, suffered multiple seizures after taking the drugs UHS staff administered.
Their complaint claims that most of the people caring for Yarushka were unlicensed. “One of the psychologists had a degree from an unaccredited internet college, and her psychiatrist was only a nurse,” Law360 reported, citing the complaint. “Instead of supervising staff, however, the mental health facility’s leadership tried to cover up the staff’s lack of qualifications,” the lawsuit alleges.
U.S. and Massachusetts officials had previously declined to intervene in the case but reconsidered after lawyers for the plaintiffs introduced new legal theories to the case. Assistant Massachusetts Attorney General Robert Patten told the presiding judge that, “It is our team’s intention to recommend intervention in this case,” and Assistant U.S. Attorney Gregg Shapiro said the U.S. is “inclined to recommend” intervention, Law360 reported.
According to Law360, “The suit has already survived trips to the First Circuit and the Supreme Court.” The Supreme Court’s June decision set a framework in which the whistleblowers would have to show that the alleged violations of unqualified staff amounted to the submission of false claims to the Massachusetts Medicaid program.
“The high court’s decision resolved a circuit split in favor of the implied certification theory, when a provider like UHS doesn’t disclose that it is out of compliance with regulations or laws,” Law 360 noted, adding that the Supreme Court said that lies of omission can be actionable under the False Claims Act.