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

A senior College of Pittsburgh Medical Heart surgeon allegedly billed the federal government for pointless surgical procedures and operations he did not carry out and immediately harmed sufferers, based on a federal false claims lawsuit filed Thursday.

The Justice Division introduced the swimsuit 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 staff.

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

Luketich allegedly usually performs three or extra complicated surgical procedures on the identical 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 criticism says.

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

To ensure that surgeons to invoice Medicare, they should be current for the process’s “essential or key” parts, and stay “instantly obtainable” for the remainder of the operation, based on rules. If essential 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 had been current throughout essential or key parts.

There isn’t a regulation prohibiting billing for overlapping surgical procedures, and Luketich invariably performs essentially the most essential parts of every operation he undertakes, UPMC spokesperson Paul Wooden mentioned.

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

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