Reuters (February 27, 2023) - The University of Pittsburgh Medical Center and the head of its cardiothoracic surgery department have agreed to pay $8.5 million to settle claims that they fraudulently billed Medicare and Medicaid for complex surgeries.
The settlement resolves a 2019 whistleblower lawsuit by a former UPMC doctor, claiming that UPMC regularly allowed James Luketich to book as many as three complex surgeries at the same time, going back and forth between patients, not participating in key parts of the surgeries, and sometimes keeping patients under unnecessary anesthesia.
Acting U.S. Attorney Troy Rivetti in Pittsburgh called the settlement "a just conclusion" to prosecutors' investigation. Jeffrey Dickstein of Phillips & Cohen, a lawyer for whistleblower Jonathan D'Cunha, said it "finally brings meaningful oversight of Dr. Luketich and UPMC."
UPMC spokesperson Paul Wood said in a statement that it continues to believe that Luketich's practice complied with federal requirements but settled the case "to avoid the distraction and expense of further litigation."
Efrem Grail, Luketich's attorney, said he hoped the settlement would lead to clearer guidance on billing "so that universally respected surgeons like Dr. Luketich can return their focus to training young doctors to save lives without having to put up with baseless claims of fraud."
Federal prosecutors intervened in the lawsuit in 2021. The case was brought under the federal False Claims Act, which allows private parties to bring lawsuits on behalf of the government and collect a portion of any recovery.
The lawsuit alleged that, in addition to resulting in hundreds of fraudulent bills to government health insurance programs, Luketich endangered patients by keeping them under anesthesia so he could attend to other patients. In some cases, patients allegedly developed complications as a result requiring further treatment.
UPMC and Luketich in November 2021 moved to dismiss the case, arguing that federal billing rules do not forbid concurrent procedures. They said that Luketich was acting as the leader of highly qualified surgical teams and was always present for the portions of the surgeries that he deemed critical.
The American Hospital Association weighed in with a brief supporting the defendants, saying that the case threatened hospitals' ability to develop their own policies for managing complex surgeries to best serve patients.
Last June, however, U.S. District Judge Cathy Bissoon refused to dismiss the case, finding that the government and D'Cunha had plausibly claimed that Luketich was not present for key portions of surgeries and that UPMC was aware of multiple internal complaints about his practices.
Two weeks later, both sides agreed to stay the case so they could negotiate a settlement.