Feds sue UPMC and its main surgeon beneath the False Claims Act

A senior College of Pittsburgh Medical Middle surgeon allegedly billed the federal government for pointless surgical procedures and operations he did not carry out and instantly harmed sufferers, in keeping with a federal false claims lawsuit filed Thursday.

The Justice Division introduced the go well with towards UPMC, College of Pittsburgh Physicians and Dr. James Luketich, a prime surgeon at UPMC Presbyterian-Shadyside. Luketich earned $2.4 million at UPMC in fiscal 2019, making him among the many firm’s highest paid workers.

The federal government’s two-year investigation started with a whistleblower grievance from a former UPMC doctor who alleges that Luketich purposefully submitted a whole bunch of false fee claims over the previous six years to Medicare, Medicaid, and different authorities well being profit applications.

Luketich allegedly typically performs three or extra complicated surgical procedures on the similar time, reserving some beneath different docs’ names, fails to take part within the “key and demanding” parts of all his surgical procedures, and forces sufferers to endure hours of medically pointless anesthesia whereas he attends to totally different duties, the grievance says.

“When physicians and different healthcare suppliers put monetary achieve above affected person well-being and sincere billing of presidency healthcare applications, they violate the fundamental belief the general public extends to medical professionals,” Maureen Dixon, particular agent answerable for the Workplace of Inspector Normal for the Well being and Human Providers Division’s Philadelphia Regional Workplace, mentioned in a information launch.

To ensure that surgeons to invoice Medicare, they have to be current for the process’s “crucial or key” parts, and stay “instantly out there” for the remainder of the operation, in keeping with rules. If crucial components of procedures involving the identical major surgeon overlap, then they’re designated as “concurrent” surgical procedures and the surgeon can solely invoice the federal government for the process at which she or he have been current throughout crucial or key parts.

There is no such thing as a regulation prohibiting billing for overlapping surgical procedures, and Luketich invariably performs essentially the most crucial parts of every operation he undertakes, UPMC spokesperson Paul Wooden mentioned.

“The federal government’s claims are fairly based mostly on a misapplication or misinterpretation of UPMC’s inner insurance policies and CMS steering, neither of which might assist a declare for fraudulent billing,” Wooden mentioned.

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