Beaumont Health takes control of its inpatient mental health servicesto a for-profit company that has been accused by regulators and whistleblowers in recent years of abusing and endangering patients and fraudulently billing Medicare and Medicaid for millions of dollars.
Universal Health Services, a publicly traded Pennsylvania-based company that operates more than 185 inpatient behavioral health centers across the country, is funding the construction of a new$40 million at Dearborn Psychiatric Hospital for Beaumont and will run day-to-day operations once it opens.
Tom Watkins, who used to run the Detroit Wayne Mental Health Authority, said he worries Universal's bottom line is making money for its shareholders, and that could put low-income patients at risk.
"Their goal is to make money, and there's not much profit in taking on very, very sick patients," Watkins said. "The beds tend not to accommodate patients from the public."
Mark Reinstein, who ran theMichigan Mental Health Associationfor nearly two decades, said he was also concerned about the whistleblower's allegationslawsuits against Universal and asked, "Are we going to see some of this stuff at the new hospital?"
Beaumont will move its three psychiatric departments to the United States from its hospitals in Taylor, Farmington Hills and Royal OakNew building, doubling of inpatient capacity to 150 beds, including 24 new beds for children and youthHospital in more than 100,000 square meters, is expected to open this fall.
"It's going to be a UHS facility with a Beaumont label," said a Beaumont psychiatrist, who was "strongly opposed" to the plan when it was announced. The psychiatrist, who requested anonymity for job security reasons, he remains frustrated by what the doctor called Beaumont's lack of transparency about staffing the new hospital.The doctor also said it's unclear whether current employees will be able to keep their jobs and seniority.
In a statement, Beaumont said employees would have to apply to work at the new campus, but the joint venture would recognize their seniority and experience. Beaumont said the timeline for the move Its in-hospital psychiatric units are subject to government regulatory approvals and the ownership breakdown will not be known until the project is complete.
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Beaumont said it considered more than a dozen potential partners, undertook an extensive review process and made its decision with input from doctors, nurses, other staff and community members. Dearborn was chosen because, according to the health system, it is easily accessible for a significant portion of its patients. Beaumont announced her plans for a new mental hospital with Universal in November 2018.
"This new campus will provide care in a state-of-the-art facility accessible to many patients," Lee Ann Odom, president of Beaumont Shared Services, said in a statement.
It's been a tumultuous year for Beaumont, one of Michigan's largest health care systems, headquartered in Southfield. Beaumont was cutting jobs and laying off staff when its finances collapsed early in the pandemic and it was laid off.unpopular merger with an out-of-state hospital system. The widening rift between doctors and executives led a former board member to ask Michigan's attorney general to intervene, saying the discord threatened the health and safety of patients.
A Free Press investigation found that Beaumont's own doctors warned executives about the Universal deal. The sanitation company agreed to the payment last year$122 million to resolve 19 federal whistleblower complaintsthat some of its mental health facilities, including two in Michigan, have abused patients and filed false claims against state insurance programs.
One of Michigan's cases against him.Havenwyck-Krankenhaus en Auburn Hills, stated that hospital practices put patients at risk of death.
According to the Justice Department, the settlement is one of the largest the department has reached in recent years in cases against medical providers accused of charging for medically unnecessary services or charging for services that were not billed.
When the whistleblower cases reached the courts, Universal was also under criminal investigation by the US Department of Justice. But the criminal queryit closed as Universal and the government moved toward a civil settlement, according to an annual report from the company.
As part of this settlement agreement, Universal is now under the supervision of the US Department of Health and Human Services, Office of Inspector General, which may do so.Review company records and speak with employees to ensure that Universal complies with its corporate integrity agreement with the federal government.
Universal "clearly denies any allegations that it was involved in any type of wrongdoing," Diane Henneman, who oversees Universal's behavioral health facilities in the Midwest, said in a statement.
but from the beginningIn 2006, according to complainants involved in the cases, company employees violently drugged patients in some hospitals to punish or incapacitate them; recruitedPatients in emergency rooms, group homes, military bases, and a soup kitchen and held patients longer than was medically necessary to receive insurance benefits.
The lawsuits also allege that some universal hospitals billed for Medicare and Medicaid group therapy sessions that never happened, distributed cigarettes and personal care products to placate patients, and threatened to call law enforcement to force parents to admit your children even if they were not medically necessary.
Separately, Michigan has been investigating universal hospitals in the state. Regulators with the Michigan Department of Licensing and Regulatory Affairs are investigating allegations of patient abuse at Havenwyck and a second universal hospital, Forest View in Grand Rapids, a Free Press investigation has found.
Documents obtained under the Freedom of Information Act show that LARA officers investigated Havenwyck in 2016 after an 11-year-old boy crashed into a bed frame without a mattress, chipping two of his upper front teeth. LARA also investigated allegations that Forest View Hospital violated its own guidelines by failing to report a patient's allegation that she had been sexually abused.
Advocates for the mentally ill say they are concerned about the new,Beaumont Hospital, run by Universal, will potentially try to fill its beds with patients who have health insurance.They leave vulnerable and uninsured patients without care. They say they are also concerned that the hospital will make decisions about which patients to admit based on their diagnosis, prognosis and past behavior.
Public patients are often poor people who have been referred for hospitalization by community mental health programs.
Watkins,A former state mental health director said it was "surprising" that the state had already issued multiple permits for the new hospital, given Universal's alleged track record. These permits include a state building permit and a permit to move and add hospital beds.
"It just doesn't add up," Watkins said.
Reinstein, who resigned from the Michigan Mental Health Association last year, said private psychiatric hospitals and community hospital mental health departments "don't want the so-called more difficult cases and they don't want cases where there isn't a prepared solution". reimbursement mechanism.
"They don't want to take in people with very complex cases or a history of misconduct, and a new for-profit private hospital is probably no different in that regard."
Reinstein said he had littleConfidence that LARA will provide appropriate supervision "based on my experience in other mental health matters." LARA, which granted the building license to the hospital last year, will be in charge of approving and supervising the installation.
Universal said in a statement that the facility will address the state's growing unmet need.behavioral health services and will “provide compassionate and professional care to all patients. ..."
Beaumont Universal Tie-Up has a following.
Roberto Sheehan,Managing Director ofMichigan Community Mental Health AssociationHe said Universal's three psychiatric hospitals in Michigan, Havenwyck, Forest View and Cedar Creek in St. Johns, while worrisome, have good reputations.
“As of this writing, the problems appear to be rooted in their corporate offices and not, as we see, in the operations of their local hospitals. Given that, we will not be opposed to this expansion," Sheehan said in an email.
Universal is one of the country'slargest health care provider.It had a turnover of 11,600 million in 2020
When Universal settled the lawsuits in 2020, the company denied wrongdoing, saying the settlement "does not constitute a finding of misconduct or a lack of proper care and treatment." ... UHS is pleased to have resolved this matter to avoid further distraction and high litigation costs, while ensuring our continued focus on providing excellent care to our patients and their families."
In a statement to Free Press, Universal said Service providers are often faced with the difficult but "economically sound option" of resolving these cases.the charges are denied.
Doctors oppose shortages
Beaumont said he sought the opinion of his doctors. But several senior Beaumont psychiatrists told the Free Press they were not consulted about Beaumont's plans to let Universal take over his units. Others said they opposed it but were rejected.
"They didn't even ask us," said Dr. Sabiha Omar, who has run the psychiatric unit at Beaumont Farmington Hills since 2019, in a February interview with the Free Press. "They told us."
She said Beaumont has also not commented on whether the employees will continue to have their jobs after the move. She said that she chose not to work at the new hospital.
Omar said his patients, 55 and older, often need medical help from other specialists at the hospital, given their age and acute medical condition. At his hospital, these patients can be transferred from his ward to a hospice or general medical floor if necessary.
Treating these elderly patients at a Dearborn psychiatric hospital will not be easy, he said.
A former Beaumont psychiatrist echoed these concerns, saying critically ill patients could die waiting for an ambulance.
"The risk far outweighs the benefit," the doctor said.,whom Prensa Libre does not mention because the doctor fears reprisals.
Psychiatric patients who realize they need to be hospitalized are already in a high state of trauma. Sometimes they hear voices or get hurt, another Beaumont psychiatrist said.
"They are fragile. A psychotic patient is dealing with terrible things in his head," the doctor said. The trip to Dearborn, "adds another burden, it's not good for them."
Other Beaumont doctors also said they would prefer to keep their psychiatric departments in their communities and have their patients in a hospital with other specialists.
Some also criticized conditions at Havenwyck, which is operated by Universal. In interviews, two former employees said the hospital was understaffed, prompting some complaints from patients.
"They don't treat people well and it doesn't manage well," said a Beaumont psychiatrist who treated a patient in Havenwyck. The patient, said the doctor, "could not be well cared for."
“It is not a healing environment. There is too much chaos,” said the doctor, who requested anonymity for reasons of job security.
Universal's Diane Henneman said Havenwyck "has done it and will continue to do it."
Doctors scrapped Beaumont's plans with Universalinstaff Meetings, saying at least one of them tried to talk about the issues.dr. david wood, Medical Director of Beaumont Health, Buthe "He wouldn't listen to us," a doctor said in an interview.
In a statement, Wood said: "I have met with many clinical leaders to discuss our mental health strategy and we have incorporated the feedback received into the process of improving our mental health services and programs."
Another psychiatrist said Beaumont shared few details about how the new hospital would be run.
“The nursing staff are upset. They are not sure about their future with UHS, they are not sure where they will end up," the psychiatrist said. “We have lost staff due to COVID, layoffs. The remaining employees ask what will happen to their positions.”
Another Beaumont psychiatrist said that moving psychiatric patients to his own hospital, away from other patients and specialists, "goes against the essence of psychiatry, which is to integrate it with the other branches of medicine."
Mental health care, the doctor said, "should be provided in a hospital that offers a range of services" and remain in the local community.
The new hospital, the doctor said, is a "throwback to the old days" when psychiatric patients were housed "far away."
Dr. Robert Trestman, a psychiatrist and chair of the Department of Psychiatry and Behavioral Medicine at Virginia Tech Carilion School of Medicine, said it's important to integrate psychiatric patients in a larger hospital with other specialists, especially when patients are frail or elderly.
But there are other reasons, too, he said. Psychiatric patients who are depressed may not be taking care of themselves, and that only makes conditions like diabetes worse.
"Depression is controlled and diabetes can be controlled," Trestman said.
In his statement, Beaumont said that the small psychiatric departments of large medical-surgical hospitals cannot provide the specialized services that patients need. The new hospital, Beaumont said, will be able to treat children, adolescents, the elderly and patients with different diagnoses, including depression, bipolar disorder and schizophrenia.
"The needs of mental health patients vary by diagnosis, and a larger, more sophisticated facility will better serve their needs," Odom said in his statement.
And like Beaumont, another of Michigan's largest hospital systems is teaming up with a for-profit public company to build a new psychiatric hospital.
Henry Ford Health System and Acadia Healthcare Co. announced in December the construction of a joint venture192-bed hospital adjacent to the West Bloomfield campus.
Henry Ford said it is expected to cost $50 million to build and equip, which Acadia will pay for. The hospital is scheduled to open in late 2022.
Henry Ford said it would move inpatient services to the new hospital from two of its locations in Ferndale and Mount Clemens. But he will maintain inpatient psychiatric units at his Wyandotte and Jackson hospitals.
Tennessee-based Acadia was also under investigation by the Justice Department for allegedly operating a billing system involving seven drug treatment centers in West Virginia. The Justice Department announced in May 2019 that it had settled the case for $17 million, calling it the largest such settlement in state history.
Acadia said the West Virginia government's civil investigation involved "complex and technical state and federal billing and coding procedures that govern reimbursement for laboratory testing services." It also noted that "no allegations or problems with the level or quality of patient care or the medical necessity of such care were identified."
Trestman said he is concerned about the trend for community hospital systems to partner with for-profit corporations to treat their psychiatric patients.
Those hospital operators could cut costs by hiring fewer nurses or using more nurses and physician assistants instead of psychiatrists, he said. Hospitals may also find ways to deny admission to the sickest and most difficult patients, saying they are too violent, too excited, he added.
"The risks are very great," Trestman said.
State reviews claims
In Michigan, LARA has investigated complaints against Universal and Beaumont. According to documents released as part of a disclosure request, the department has found more serious violations at Universal than at Beaumont in recent years.
A Free Press review of records provided by LARA revealed that the department found only one valid complaint against a psychiatric unit in Beaumont during a five-year period ending at the end of 2020.
LARA researchers concluded that in 2018, an employee at Beaumont Farmington Hills administered an antipsychotic medication to an 85-year-old patient with depression and bipolar disorder to help her fall asleep. This approach,LARA said,violates the rules against the use of chemical restraints for the convenience of staff. LARA did not ask the hospital to take any action to resolve the case.
In universal hospitals, LARA found four valid complaints in the same five-year period.
In one case, state regulators found that Forest View Hospital had violated its own guidelines by failing to report a patient's allegation that she had been sexually abused to law enforcement. Despite this finding, according to the documents, LARA did not require any corrective action.
But in other cases, LARA took action against Universal hospitals.
The department investigated Havenwyck after receiving two reports that an 11-year-old boy with bipolar disorder had been injured in 2016.
LARA reviewed the security camera footage of the room where the staff had taken the child to hold him. The patient, LARA said, "tried to escape from the staff and tried to hit him." LARA said two staff members held the boy at the foot of the bed by the arms. The boy struggled and "suddenly pushed himself forward and landed face-first on the bed."
His face met the hard frame. Two of her upper front teeth were broken.
LARA interviewed the boy who said: "Two people pushed me onto the bed in the bathroom with no mattress and I broke my teeth on the bed frame."
But one of the employees, a nurse, told LARA that the boy was angry and threw a mattress at two employees. The nurse described the boy as "out of control and we couldn't get him to calm down." The nurse said they were trying to get him to bed so another nurse could give him an injection to calm him down.
"When we lifted him up after the injection, I saw two small teeth and he told me: 'Look what you did to my teeth,'" the nurse told LARA.
During the investigation, a LARA officer observed the mattress on top of the bed and described it as a "sports camping" type mattress that did not fit the frame and would slide off the bed when touched.
LARA concluded that the hospital had violated federal regulations by failing to ensure that the bed in the isolation ward was safe.
As part of its remedial plan with the state, the hospital has agreed to retrainall of your nurses focusing on proper restraint techniques.
Universal In a statement to the Free Press, he called it "an unfortunate accident" and noted that Havenwyck used the incident to "conduct additional training with our staff on grab bars."
LARA also investigated how Universal'sForest View processed a claim from a 52-year-old patient who reported being sexually assaulted by two employees. Forest View officials never reported the claim to authorities as required according to hospital guidelines, found LARA.
The next day, the patient called her sister, who contacted the police.
“The patient wanted to call 911 but called her sister and her sister called the police to investigate the alleged assault. She talked about it crying," according to a hospital. Report of the social worker.
Two sheriff's department officers spoke to the patient, who told them that she "was sexually assaulted by two male employees on two separate occasions," according to Forest View.Received nursing letter from LARA. The state investigation records made available to the Free Press contain no police findings on the patient's claim.
LARA's report states that the hospital later investigated and concluded that the patient's claims could not be substantiated. The patient suffered from a variety of illnesses including bipolar disorder, schizophrenia, major depressive disorder, agitation, psychosis, auditory and visual hallucinations.
The hospital manager, who was not named in the investigation report, told LARA: "It should have been reported to the police (from) our side instead of the client."
According to the CEO, all employees have been trained to report abuse. But when LARA requested documentation, the hospital only provided minutes of a staff meeting, which apparently included no training. In his statements to Prensa Libre, Universal did not respond to a question about the training.
According to LARA records, the department did not take any action against Forest View.
Whistleblowers sound the alarm
Universal's misconduct allegations are the result of nearly a decade of lawsuits brought by insiders at the company.
The whistleblowers' lawsuits were brought under the federal False Claims Act, which allows private parties to bring lawsuits on behalf of the federal government and participate in settlement funds.
Experts say these cases are being secretly filed so the Justice Department can have 60 days to investigate the claims. The government can request extensions until it makes a decision on how to proceed: it can intervene, ask the judge to dismiss the case, or allow the complainant's lawyers to proceed. While these begin as civil matters, investigations beginmay result in criminal charges.
bailiff akel, a Troy employment attorney, cited the provisions among the false claimsLaw "the only occasion in which a citizen can help the government to prosecute fraud. It is a great weapon to fight corruption."
Eighteen of Universal's cases were settled collectively, with Universal agreeing to pay penalties totaling $117 million to the federal government and several states, including about $2.4 million to Michigan. (A 19 case was settled separately for $5 million.)
erin campell, a Cincinnati attorney representing the whistleblowers, cited the large number of Universal lawsuits and the size of the"Extraordinarily rare" comparison in the case of purported billing for services that are not medically necessary. She said the Justice Department's decision to intervene in the 19 lawsuits suggests taxpayers were wronged and owed millions of dollars.
david kwok, an associate professor at the University of Houston Law Center who investigates the False Claims Act, said the government's case against Universal involved a complicated investigation that was part of a larger Justice Department effort.
"Unfortunately, this is a small part of the vast amount of health care fraud that has grown in recent decades," Kwok said in an interview.
schlein brand, with the law firm of Baum Hedlund Aristei & Goldman, filed the first of the whistleblower cases in May 2012 in Florida federal court against Universal's River Point Behavioral Health. The complainant who representedalleged that Jacksonville Hospital improperly withheld patients to exhaust their insurance benefits, admitted patients based on their insurance, billed for unnecessary services, and conducted group therapy sessions from interns, unlicensed staff, and even former patients.
Schlein said she wishes she could call the allegations the most egregious, but "they're all too common when you start investigating large-scale health care fraud."
Schlein said the settlements did not require Universal's admission of wrongdoing, but added: "I can probably suggest that a company is unwilling to pay $117 million for allegations it believes are false and false."
As part of the settlement, Universal Health agreed to enter into a corporate integrity agreement through 2025.with the Office of the Inspector General of the United States Department of Health and Human Services.
Under the agreement, Universal must hire an independently selected monitor to assess the company's protections for its mental health patients and report to the Inspector General. In addition, an independent organization conducts annual reviews of claims submitted by Universal Inpatient Behavioral Health Centers to the federal government.
"Hopefully it will have a positive effect on people using (universal) and other mental health services. If we can improve care a little bit, we've accomplished a lot," Schlein said.
However, this isn't the first time Universal has come under scrutiny from a federal regulator.
When Schlein filed his case in 2012, Universal's health care system in South Texas was already covered by a corporate integrity agreement. The Justice Department claimed that the system illegally paid doctors to refer patients to hospitals within the group.
The hospital system agreed to stricter federal oversight and paid $27.5 million to settle the whistleblower's case.
In Michigan, two whistleblowers accused UniversalHavenwyck Hospital in Auburn Hills in 2019 for routine failures to provide adequate medical care.
His lawsuit in the US District Court in Detroit alleged that Havenwyck did not have the necessary personnel, medications, personal protective equipment, andServices to adequately treat some of the sickpatients
As a result, according to the lawsuit, public funds have been misappropriated and there have been medical emergencies and patient deaths.
The lawsuit identified one of the dead as J.Y. He said the patient exceeded the hospital's 350-pound weight limit by nearly 50 pounds.
She was known to be violent towards staff during previous stays at Havenwyck. During her last stay, the woman assaulted one of the doctors and she was found dead in her room five days later, according to her lawsuit.
According to the obituary the hospital filed with the state, Havenwyck admitted the patient to Detroit Receiving Hospital. She had been found walking barefoot and she was unable to attend to her basic needs.
According to the obituary, the Oakland County coroner was able to identify her as Jane Young.,we arehe died in July 2018 from cardiovascular disease and obesity. The Free Press was unable to reach any of Young's survivors. The lawsuit alleged that her stay at Havenwyck was fraudulent because the hospital should not have admitted her because she did not have the staff or resources to properly care for her.
The lawsuit identified another patient who died at Havenwyck when K.J. He was admitted in January 2018 with no reliable medical or psychiatric history and his guardian was not contacted for further information.
The lawsuit states that her medical condition and past history were unclear to Havenwyck during her hospitalization. The lawsuit said she did not attend groups or participate in active treatment.
She was found unconscious in her room six days after her admission and died. KJ is Kathy Jawor, 57, who died of heart disease, according to the coroner.
Three years after his sister's death at Havenwyck, John Jawor of Novi said he was still puzzled by her death.
Kathy Jawor suffered from schizophrenia and had been hospitalized for her entire adult life. In her last days, she was initially admitted to Garden City Hospital before being transferred to Havenwyck. Over the next week, John Jawor said, he and his sister talked on the phone. During one of those conversations, he recalled asking her, "Get me out of here." She had said similar things during previous hospital stays.
"She seemed drugged," Jawor said. That was also routine during her hospital stays.
She took her clothes and toiletries to Havenwyck, but said she couldn't see her because she hadn't come during visiting hours.
Then he got the call: Kathy,who said he weighed 250 pounds, had been found sitting on the hospital floor. And his sister could not be revived.
"Why was she sitting on the floor?" he remembers thinking of himself. "I found it really strange... Questions popped up in my head."
He said he raised questions because he called 911 to help Kathy, who was severely overweight, get up a couple of times from her Dearborn Heights home.
He said that the doctors who treated Kathy tended to try different drugs, different concentrations of drugs, and different combinations of drugs.
The doctors, as well as the families of these patients, seemed to be "grasping a straw" in their treatment.,Jawor said. "You don't have all the answers."
He also has his regrets.
"I wish I had loved her just the way she was. I should have loved her where she was instead of always trying to heal her, heal her when she wasn't in my hands," Jawor said.
In Havenwyck, the complainants said there were other problems.
Upon admission, patients were supposed to receive a 50-minute psychological evaluation by trained physicians, but sometimes received less than 10 minutes, according to the lawsuit.
Those assessments were so cursory that they failed to account for patients' weights, life-threatening illnesses and current prescriptions, the lawsuit says. Some patients also did not receive significant medical attention or group therapy, the lawsuit claims. The complainants claimed that the patients were "warehoused rather than treated medically."
The lawsuit also alleged that the hospital mishandled patients' medications. It was alleged that the patients had their current medication discontinued and almost all received psychiatric medication "within the first day of seeing a psychiatrist, including patients who do not appear to require hospitalization at all."
“In short, patients are chemically restrained from extending their stay on Medicare or Medicaid without proper justification and in violation of the Michigan Mental Health Code,” the lawsuit states.
The 2019 lawsuit, which settled with 18 other people, was brought by two whistleblowers, Sandra McLauchlin, who worked in nursing leadership, and Christina Varner, a registered nurse. Her attorney, Sarah Prescott, declined to comment..
Universal said Havenwyck denies the lawsuit's allegations.
At Forest View Hospital in Grand Rapids, former employee Heidi Parent-Leonard accused the hospital of cheating on federal insurance programs.
Father Leonard, a case manager at the hospital for two years, alleged in court papers that the hospital admitted patients who did not require hospital treatment and that one of the doctors, Dr. Jahandar Saifollahi, improperly provided and referred services are patented to him and the hospital in violation of the law.
dr. Saifollahi told the Free Press that he did not handle billing, Forest View did.
"I never charged them anything," he said.
saifolahi,a defendant in the lawsuit said he settled the case but admitted he had committed no crime. Universal said an investigation was underway and the hospital was ending its relationship with Saifollahi.
According to a press release from the Parent-Leonard attorneys who announced the settlement last summer, Saifollahi and his medical practice have settled $85,000 in claims.
Mother Leonard said in a statement that she was surprised by the lack of services patients at Forest View were receiving. She said Saifollahi would line up the patients in the hallway and spend 5 minutes talking to each one, one at a time.
"Nobody got the help they needed," Parent-Leonard said in the news release. (A lawyer for Parent-Leonard said he was not available for an interview.)
He said in his statement that he hopes the hospital and Universal "learn from these lawsuits and foster a culture of quality, respect and honesty in dealing with their patients."
Contact Jennifer Dixon at: 313-223-4410 or firstname.lastname@example.org