“Lock them in. Bill their insurer. Kick them out. How scores of employees and patients say America’s largest psychiatric chain turns patients into profits.” [1]
That is how Rosalind Adams, BuzzFeed News Reporter, headlined her article written after a year-long investigation into the policies and practices of Universal Health Services (UHS), a corporation that owns over 200 psychiatric facilities in the US.
UHS admitted almost 450,000 patients last year with revenues of nearly $7.5 billion dollars and profits of around 30%. Over one third of this revenue was paid by Medicare and Medicaid. [2]
BuzzFeed staff interviewed 175 current and former UHS staff (18 were executives who ran the facilities). Another 200 additional interviews were done with patients, government investigators and experts. They also acquired UHS internal documents that presented a damning view of how the hospitals are being run.
Employees were pressured to fill the beds even if it meant exaggerating symptoms of potential patients, altering their comments to make them appear suicidal and holding them involuntarily and illegally in the hospital until their insurance payments ran out.
Hospitals were also found to be deliberately kept understaffed (to save on expenses), violating laws on how psychiatric drugs are dispensed, not cleaning the facilities and overcrowding the units with too many patients.
The Office of the Inspector General for the US Department of Health and Human Services in 2013 filed subpoenas on UHS Delaware, Inc. and over twenty UHS psychiatric hospitals for Medicare fraud. [3]
On the day the BuzzFeed investigation report was published, UHS stock dropped 12% prompting the company to issue its latest denial in a press release calling the report an “inaccurate portrayal”. Altogether, the stock has fallen by 20% since the article was published, reducing the company’s market value by $2.4 billion. [4]
Sen. Elizabeth Warren of Massachusetts (where 5 UHS facilities are under investigation) wasn’t buying any excuses from UHS, “People seeking mental health services deserve high-quality treatment — not abuse at the hands of companies that are locking patients up to turn a profit and defraud taxpayers. The Department of Justice must put an end to these shameful practices for the safety of patients both here in Massachusetts and across the country.” [5]
Sen. Grassley of Iowa, who chairs the Senate judiciary committee, wrote immediately to the Inspector General of the Department of Health and Human Services summarizing the important points of the BuzzFeed report and giving a link to the full report. The Senator called on the IG to reply by December 23^rd giving the detailed steps that his office will take to investigate the abuses at UHS. [6]
UHS Advertises Free Mental Health Assessments, Involuntarily Locking Up Applicants
By law psychiatric patients and people coming in to ask about hospital services or take a mental health assessment cannot be held involuntarily unless they are exhibiting a clear threat to themselves or others.
But UHS has violated the trust placed in them to honestly determine if a patient needs to be confined. This misleading ad and the resultant actions taken by Highlands Behavioral Health in Littleton Colorado illustrate this point:
“Highlands can help but only if you call. To speak with a caring professional or to schedule a free confidential assessment 24 hours a day, 7 days per week, please call.” [7]
UHS then carefully tracked the per cent of those taking an assessment that became in-hospital patients.
“The goal when you’re on the phone with someone is to always get them into the facility within 24 hours,” said a former admissions employee who worked at three UHS facilities in Texas. “And the reason for getting them into the facility is that once they stepped foot in, they are behind locked doors.”
“People don’t understand,” said a former intake worker at Salt Lake Behavioral Health in Utah. “They think we’re going to diagnose them for anxiety or depression.” She added, “Our goal is to admit them to the hospital.” [8]
UHS Learns Using the Medicare Code for “Suicidal Ideation” = Profits
Former UHS admission workers, pressed to keep beds full, learned to alter passing statements that people made during the mental health assessments into something that made them look like a person dangerous to themselves or others. “Suicidal ideation” marked on a form led to almost certain admission into the psychiatric hospital and it became the UHS formula to ensure that insurance paid the hospital.
One therapist who did assessments for University Behavioral Health in Denton, TX stated that with enough leading questions about suicide “we can get the person to say, ‘It’s still on my mind.’”  [9]
In Salt Lake City intake would ask “Have you ever thought about suicide?” Then “If you had a (suicide) plan, how would you do it?” Then any answer would be considered a “plan” and the patient could be immediately locked up in the psych ward. [10]
By 2013 the suicidal ideation code appeared in more than half of all Medicare claims submitted by UHS hospitals.
UHS Finds that Cutting Staff and Giving Bad Care = Profits
The Buzzfeed investigators found several people who ran UHS hospitals who told them their corporate bosses’ policy was to cut staff year after year to increase profits no matter the dangers to other staff or the patients.
In one example a former hospital head was told to get rid of 9 nurses in order to increase profits. She resigned instead.
Four doctors from different UHS hospitals complained to BuzzFeed that they had such heavy caseloads they only had a few minutes with each patient visit and could not evaluate the patient’s mental health in any realistic way.
Mental health technicians, the staff with the least training, often spent the most time with patients at UHS hospitals. Over a dozen techs said they sometimes felt unsafe as they scrambled to monitor the high numbers of patients. One compared the environment to a “war zone.” [11]
In one egregious example of bad care, a man addicted to opiates was treated by an UHS staff doctor with a synthetic opioid called fentanyl that is more potent than heroin. A nurse then mistakenly wrote on his chart that the patient was due for another fentanyl dose. The patient got very sick and was put into a quiet room where staff were to check on him every fifteen minutes. His chart records he slept through the night. But at 9:15 am in the morning he was found in rigor mortis having been dead for hours. – killed by acute fentanyl toxicity.
His mother stated, “They killed an opiate addict with opiates. It’s unbelievable to me that could happen.”
She and her family did win a settlement with the UHS hospital for an undisclosed amount.
UHS Learns Keeping Them In Until the Insurance Runs Out = Profits
BuzzFeed News found two dozen current and former employees in 14 different UHS hospitals around the US who stated the policy was to hold patients captive until their insurance ran out to achieve maximum possible payments.
A divisional vice president, Sharon Worsham, repeated a mantra to them: “Don’t leave days on the table.” [12]
It was common practice and expected that a patient stayed the full number of days that would be paid by their insurance. Staff and doctors participated in “flash meetings” in which the administrators went down the names of patients discussing treatments. But the meetings also had the purpose of reviewing how many days they had left and how to use them.
Two people who worked at Highlands Behavioral in Colorado when Paul Sexton, then the head of the hospital, led the daily flash meetings, said he ran down the list demanding an explanation for each early discharge asking, “Why are they going home?”. [13]
A better question is “Why the doors to UHS psychiatric hospitals are still open and why are they receiving tax payer money?”
 
[1] https://www.buzzfeed.com/rosalindadams/intake?
[2] Ibid
[3] https://www.documentcloud.org/documents/3217720-160590-UHS-2015-Annual-Report-FINAL-1.html#document/p53/a328296
[4] https://www.buzzfeed.com/matthewzeitlin/healthcare-giant-uhs-has-lost-2-4-billion-in-value-in-a-week?utm_term=.fsz6005dD#.yu01MM3VK
[5] https://www.buzzfeed.com/rosalindadams/lawmakers-sound-alarms-on-uhs-psychiatric-hospitals?
[6] https://www.documentcloud.org/documents/3235012-2016-12-09-CEG-to-HHS-IG-Buzzfeed-UHS.html
[7] https://www.buzzfeed.com/rosalindadams/intake?
[8] Ibid
[9] Ibid
[10] Ibid
[11] Ibid
[12] Ibid
[13] Ibid