Feds sue UPMC and its leading surgeon under the False Claims Act
A senior University of Pittsburgh Medical Center surgeon allegedly billed the government for unnecessary surgeries and operations he didn’t perform and directly harmed patients, according to a federal false claims lawsuit filed Thursday.
The Justice Department brought the suit against UPMC, University of Pittsburgh Physicians and Dr. James Luketich, a top surgeon at UPMC Presbyterian-Shadyside. Luketich earned $2.4 million at UPMC in fiscal 2019, making him among the company’s highest paid employees.
The government’s two-year investigation began with a whistleblower complaint from a former UPMC physician who alleges that Luketich purposefully submitted hundreds of false payment claims over the past six years to Medicare, Medicaid, and other government health benefit programs.
Luketich allegedly often performs three or more complex surgical procedures at the same time, booking some under other doctors’ names, fails to participate in the “key and critical” portions of all his surgeries, and forces patients to endure hours of medically unnecessary anesthesia while he attends to different tasks, the complaint says.
“When physicians and other healthcare providers put financial gain above patient well-being and honest billing of government healthcare programs, they violate the basic trust the public extends to medical professionals,” Maureen Dixon, special agent in charge of the Office of Inspector General for the Health and Human Services Department’s Philadelphia Regional Office, said in a news release.
In order for surgeons to bill Medicare, they must be present for the procedure’s “critical or key” portions, and remain “immediately available” for the rest of the operation, according to regulations. If critical parts of procedures involving the same primary surgeon overlap, then they are designated as “concurrent” surgeries and the surgeon can only bill the government for the procedure at which he or she were present during critical or key portions.
There is no law prohibiting billing for overlapping surgeries, and Luketich invariably performs the most critical portions of each operation he undertakes, UPMC spokesperson Paul Wood said.
“The government’s claims are rather based on a misapplication or misinterpretation of UPMC’s internal policies and CMS guidance, neither of which can support a claim for fraudulent billing,” Wood said.