Universal Health Services, Inc. v. United States et al. ex rel. Escobar et al.

Arbour Counseling Services, a mental health facility subsidiary of Universal Health Services (Universal) (defendant), treated Yarushka Rivera, who was diagnosed with bipolar disorder by a purported psychologist and later died from a seizure after an adverse reaction to medication prescribed by a purported psychiatrist; Rivera's parents (plaintiffs) discovered most Arbour employees were unlicensed, including that the diagnosing 'psychologist' held an unaccredited online degree and had been rejected for state licensure, and the prescribing 'psychiatrist' was actually a nurse lacking prescribing authority. When submitting Medicaid reimbursement claims, Arbour staff misrepresented their qualifications and licensing status, and the state Medicaid program, unaware, paid the claims; Rivera's parents filed a qui tam suit alleging Universal defrauded Medicaid by failing to disclose these regulatory violations, and after the trial court dismissed the suit on the ground the regulations were not an express condition of payment, the appellate court reversed, holding a regulatory requirement could be an implied condition of payment.