• September 17, 2021

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

Sep 6, 2021

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, in line with 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 workers.

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

Luketich allegedly usually performs three or extra complicated surgical procedures on the identical time, reserving some below different medical doctors’ names, fails to take part within the “key and significant” parts of all his surgical procedures, and forces sufferers to endure hours of medically pointless anesthesia whereas he attends to completely 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 packages, they violate the essential belief the general public extends to medical professionals,” Maureen Dixon, particular agent answerable for the Workplace of Inspector Basic for the Well being and Human Companies Division’s Philadelphia Regional Workplace, stated in a information launch.

To ensure that surgeons to invoice Medicare, they should be current for the process’s “vital or key” parts, and stay “instantly out there” for the remainder of the operation, in line with rules. If vital elements 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 vital or key parts.

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

“The federal government’s claims are reasonably primarily based on a misapplication or misinterpretation of UPMC’s inner insurance policies and CMS steerage, neither of which might help a declare for fraudulent billing,” Wooden stated.

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