UPMC, others to pay government $2.5 million in Medicare billing case

UPMC and three related entities have agreed to pay the United States $2.5 million to partly settle a 2012 lawsuit claiming they deliberately overbilled federal health insurance programs for surgeries, the U.S. Attorney's Office said Wednesday. 


The settlement comes in a whistleblower lawsuit by former UPMC employees Anna Mitina and Drs. J. William Bookwalter and Robert J. Sclabassi. The lawsuit was unsealed Wednesday. 


The settled claims contend that UPMC billed Medicare for neurosurgeons it claimed assisted or supervised other medical staff in surgeries when they didn't or that one neurosurgeon billed for procedures that weren't performed, U.S. Attorney David Hickton said in a news release. 


“Today's settlement demonstrates our commitment to protecting federal health care programs from fraud,” he said. 


The lawsuit includes UPMC, the University of Pittsburgh Physicians, UPMC Community Medicine Inc. and Tri-State Neurosurgical Associates-UPMC Inc. They don't admit liability in the lawsuit, according to the release. 


UPMC discovered the overbilling and disclosed it to the government, said UPMC spokeswoman Gloria Kreps. The doctors didn't submit the bills, she said. 


“UPMC took steps to strengthen the processes and practices in the billing systems that had allowed incorrect billing,” she said. “Under the settlement, UPMC admits no liability.” 


The government elected not to pursue the other claims in the lawsuit. If the three former UPMC employees pursue those claims, “UPMC will defend the matter vigorously,” she said. 


After the whistleblowers filed the lawsuit, it was kept under seal while the FBI and the inspector general for the Department of Health and Human Services investigated their claims and federal prosecutors decided whether to intervene in the case. 


The government decided to intervene only on the claims that were settled, according to court documents. 


The unsettled claims include allegations that UPMC promoted medically unnecessary surgeries and paid physicians more than they would typically receive for a surgery to encourage them to refer more surgeries to UPMC facilities. 


The release says that the whistleblowers plan to further pursue those claims. Attorneys for the whistleblowers either declined to comment or couldn't be reached. 


Brian Bowling is a Tribune-Review staff writer. Reach him at 412-325-4301 or bbowling@tribweb.com.

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