Youth behavioral health residential treatment facilities could face more scrutiny following additional public pressure by a powerful federal lawmaker.
On Wednesday, Senate Finance Committee Chair Ron Wyden (D-Oregon) publicly called on the U.S. Department of Justice (DOJ) to investigate four major behavioral health providers to determine if their youth residential treatment programs committed Medicaid fraud.
Wyden also requested that the DOJ investigate whether young people’s civil rights are violated when they are placed in residential facilities, as opposed to receiving community-based care.
The four behavioral health providers named are Universal Health Services, Acadia Healthcare (Nasdaq: ACHC), Devereux Advanced Behavioral Health and Vivant Behavioral Healthcare.
“Vulnerable children are being used as pawns to maximize the profits of these facilities — and American taxpayers are footing the bill. More often than not, these kids aren’t even getting the basic care they need, and instead are in many cases experiencing serious neglect and abuse,” Wyden said in a statement. “With the health and safety of kids involved — and pages of evidence — it’s time for the DOJ to get involved.”
The letter, addressed to U.S. Attorney General Merrick Garland, said that residential treatment facilities do not adequately train or hire staff, operate substandard facilities and offer minimal therapeutic treatment. It also said that, while these programs are advertised as short- or medium-term interventions, children sometimes remain for many years.
The risk of harm to children in residential treatment facilities is “endemic” to how these programs operate, Wyden wrote in his letter to the DOJ.
He attested that the four named providers, which receive billions from Medicaid, bill the federal health plan for services that were not effectively rendered and therefore negatively impacted children’s health. Wyden also said that facilities often fail to adhere to Centers for Medicare & Medicaid Services (CMS) regulations and misuse restraints and seclusion.
CMS rules state that psychiatric residential treatment facilities may not receive Medicaid funds if they use restraint and seclusion of any kind to coerce, discipline or retaliate against children.
Additionally, the letter said that these programs consistently fail to document treatment courses and expose children to harmful environments that, in part, fail to prevent self-harm and abuse.
“In light of the seriousness of these facts, I formally refer this matter to DOJ and request that you
launch an investigation into violations of CMS regulation and violations of the [False Claims Act] (FCA) at [residential treatment facilities where youth are treated, as well as any other violations that DOJ identifies,” the letter read.
In a separate letter, Wyden said that states have violated the Americans with Disabilities Act
(ADA) by placing children in segregated behavioral health facilities, removing them from their communities rather than focusing on enhancing access to community-based care.
“Where state systems remove children to these settings before offering a continuum of in-community services that can meet a child’s needs, they may be violating the civil rights and treatment needs of children in their care and other system-involved youth,” the letter read.
Wyden also shared evidence that states fail to prepare for a child’s reintegration into their community following discharge from a residential treatment facility. This failure can result in decreased community connections, especially in cases when a child is moved to an out-of-state facility, he wrote.
He reported that, in some cases, residential treatment programs provide inadequate, segregated education, and that this, along with the above factors, contributes to a child staying separated from their community.
Youth residential treatment programs have been the subject of increasing scrutiny from lawmakers. Earlier this year, a group of lawmakers introduced a bill called the Stop Institutional Child Abuse Act designed to increase information sharing among states to better identify institutional child abuse.
Wyden has previously called on the Biden-Harris administration to increase oversight on youth residential treatment facilities.
These pushes followed the publication of a report by the Senate Finance Committee asserting that the behavioral health industry intentionally “profits off taxpayer-funded child abuse.” Industry insiders pushed back against these allegations, saying that the report was biased, missed important context and would not improve the status quo, among other criticisms.
Previous research has shown that states do not collect the necessary information to identify patterns of maltreatment of children in residential behavioral health facilities. Wyden commented on these findings, saying that it is the latest evidence in a series of investigations demonstrating that youth residential behavioral health facilities do more harm than good.
