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UPMC could still face lawsuit by Wholey over billing claims

He's a pioneer physician who co-founded a highly regarded medical device company. She's a philanthropist who fancies furs, collects contemporary art and sits on the board of the Pittsburgh Opera.

Dr. Mark Wholey and his wife, Roseanne, a power couple from Fox Chapel and a fixture in Pittsburgh's social scene, are embroiled in a lawsuit against Mark Wholey's former employer, health giant UPMC.

Roseanne Wholey, who brought the suit, contends UPMC and a cardiology office overbilled and double-billed federal health insurers including Medicare, Medicaid and Veterans Affairs for interventional radiology procedures such as angioplasties.

Although federal attorneys declined last month to prosecute her claims, Wholey, a medical-billing specialist, said she might keep the case alive through a little-known provision that lets citizens sue on the government's behalf.

A win could mean a windfall for the family, which could keep up to 30 percent of all damages if a court agrees with Wholey, according to legal analysts. But she said that's not why she started the whistle-blower suit. Instead, she said, she felt an obligation to alert the government. “It's not like I was looking for personal monetary gain. I was infuriated at the situation that occurred because I had always done my husband's billing,” said Roseanne Wholey, 60. Downtown-based UPMC declined to comment. Attorneys for co-defendant Donohue Cardiology Associates in Washington, Pa., could not be reached.

Mark Wholey, 87, an interventional radiologist, worked for the practice from January 2011 to July 2012 and saw patients at its UPMC Shadyside office, according to court filings. In a separate civil case pending in Allegheny County Court, he claims Donohue underpaid him. His attorney, Timothy R. Berggren, said he could not discuss how much money Mark Wholey is due.

The case uncovered documents that Roseanne Wholey alleges reveal a host of fraudulent practices, including billing for procedures more intensive than what her husband actually performed.

Her Downtown-based attorney, Andrew M. Stone, described the pattern as a scheme in a 26-page federal court filing in October 2013. Those claims remained confidential until last week, when U.S. District Court Judge Joy Flowers Conti ordered the case unsealed. Federal prosecutors refused in a Feb. 27 notice to take up the case under the False Claims Act, leaving Roseanne Wholey to decide whether she wants to tackle the case without the government's backing. A spokeswoman for David Hickton, the U.S. Attorney for Western Pennsylvania, declined to comment.

The government refuses to pursue as many as 70 percent of complaints filed under the act, sometimes because of limited prosecutorial resources, Stone said. He had not yet discussed with Roseanne Wholey whether to proceed with the civil action.

She assisted her husband in the administration and management of his practice and has more than 30 years of experience as a medical and billing consultant, according to her lawsuit.

“She's a wonderful woman,” said Jacinta Dvorak O'Connell, who sits on the board of the nonprofit St. Lucy's Auxiliary to the Blind. Roseanne Wholey is the organization's board president. “She's very dedicated to charities. She works very hard at every volunteer position that she holds,” O'Connell said.

Mark Wholey, considered a leader in his field, has specialized in peripheral vascular procedures that help patients with hardened arteries. He co-founded Medrad, a medical imaging company acquired by German health care giant Bayer in 2006. He and co-founder M. Stephen Heilman in 1964 developed the first flow-controlled angiographic injector commercialized in the United States. “Mark's had a full life. He's been an innovator in interventional medicine. He's been a leader in that field,” said Heilman, 81, who was not familiar with the lawsuits. “He's got a real quick mind and a lot of energy.”

Wholey spent 36 years as chairman of the department of radiology at UPMC Shadyside but broke ties with the health system in 2012, when he joined rival Allegheny Health Network. Allegheny Health officials in 2012 said Wholey had been appointed director of Allegheny General Hospital's Center for Vascular and Neurovascular Interventions. Downtown-based Highmark Health owns the seven-hospital network. “Having Dr. Wholey bring his world-renowned expertise to Highmark is an honor for our company and a great benefit to our members,” Allegheny Health CEO John Paul said at the time. Wholey serves as an innovations adviser for the institute, according to a company spokesman.

The federal complaint initiated by his wife is “very well-crafted,” said Arthur D. Hellman, a law professor at the University of Pittsburgh. A lot of citizen complaints brought forth under the False Claims Act target misuse of federal money within the Medicare and Medicaid programs, he said. “It would be impossible for government officials to catch all fraud,” Hellman said.

Medical editor Luis Fábregas contributed to this report. Adam Smeltz is a Trib Total Media staff writer.

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