Feds Sue UPMC Over Healthcare Fraud Allegations
By: KDKA-TV News Staff
PITTSBURGH (KDKA) - The United States has filed a suit against UPMC, its physician practice group and the chair of its Department of Cardiothoracic Surgery over healthcare fraud allegations.
U.S. Attorney Stephen Kaufman announced the suit Thursday, saying the complaint was the result of a two-year investigation into allegations brought by a former UPMC physician under the False Claims Act's whistleblower provisions.
Prosecutors accuse UPMC, the University of Pittsburgh Physicians and Dr. James Luketich of submitting hundreds of materially false claims for payment to Medicare, Medicaid and other government health benefit programs over the past six years.
The complaint also accuses Dr. Luketich, the longtime chair of UPMC's Department of Cardiothoracic Surgery, of regularly performing up to three, complex surgical procedures at the same time, failing to participating in all of the "key and critical" portions of his surgeries and forcing patients to endure hours of unnecessary anesthesia time as he moved between operating rooms.
"The laws prohibiting 'concurrent surgeries' are in place for a reason: to protect patients and ensure they receive appropriate and focused medical care," said Acting U.S. Attorney Kaufman. "Our office will take decisive action against any medical providers who violate those laws, and risk harm to Medicare and Medicaid beneficiaries."
UPMC released this statement:
"Dr. James Luketich is a uniquely skilled and world-renowned cardiothoracic surgeon. As the government itself concedes in its Complaint:
"Many of [Dr.] Luketich's surgical patients are elderly, frail, and/or very ill. They include the 'hopeless' patients . . . who suffer from chronic illness or metastatic cancer, and/or have extensive surgical histories, and choose UPMC and [Dr.] Luketich when other physicians and healthcare providers have turned them down.
"When treating these patients, Dr. Luketich leads teams of highly skilled surgeons and other clinicians through complex procedures that frequently last more than 12 hours. As the government also concedes, Dr. Luketich always performs the most critical portions of every operation he undertakes.
"No law or regulation prohibits overlapping surgeries or billing for those surgeries, let alone surgeries conducted by teams of surgeons like those led by Dr. Luketich. 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. UPMC and Dr. Luketich plan to vigorously defend against the government's claims."
