UPMC and a cardiology office routinely overbilled and double-billed federal health insurers including Medicare, Medicaid and Veterans Affairs for radiology procedures, the wife of a radiologist claims in a federal lawsuit unsealed Wednesday.
Roseanne Wholey, wife of Dr. Mark Wholey, says in the lawsuit that she detected the pattern while handling the medical records for her husband's practice. She's suing on behalf of the government to recover the overpayments.
Wholey filed the lawsuit in October 2013. The case was kept under seal pending a review by the government on whether it wanted to take over the case or allow Wholey to pursue the claim on the government's behalf.
The government filed a notice Feb. 27 that it had elected not to intervene but the case can't be settled without its permission. U.S. District Judge Joy Flowers Conti ordered the case unsealed Wednesday. Andrew Stone, Wholey's attorney, and representatives of UPMC and Donohue Cardiology Associates couldn't be reached for comment Wednesday.
Wholey claims both medical providers billed for more intensive — and therefore more expensive — procedures than her husband actually performed on patients while working for them. They also “unbundled” procedures to charge for each step in a procedure separately as well as billing for the overall procedure, the lawsuit says.
Brian Bowling is a staff writer for Trib Total Media.