By Kris B. Mamula / Pittsburgh Post-Gazette
A whistleblower lawsuit that was filed against UPMC over bonuses for its neurosurgeons has been revived after a federal appeals court on Tuesday reversed a lower court ruling that dismissed the claims.
The 3rd U.S. Circuit Court of Appeals reversed a ruling last year by U.S. District Court Judge Cathy Bissoon to throw out a three-count civil lawsuit filed by neurosurgeon J. William Bookwalter, physician Robert J. Sclabassi and operating room technician Anna Mitina against UPMC and 13 of its neurosurgeons for making false claims and related offenses. The plaintiffs are former UPMC employees.
Judge Bissoon had dismissed the lawsuit in March 2018 after expressing “strong doubts” about its ability to overcome “numerous pleading deficiencies.”
Andrew M. Stone, who represents the former UPMC employees, said he was pleased by the 40-page 3rd Circuit ruling. “We’re pleased with the court’s ruling and look forward to proceeding with the case,” said Mr. Stone, a principal at Stone Law Firm, which has offices in Downtown.
UPMC lawyer Stephen A. Loney Jr., from the Philadelphia law firm of Hogan Lovells, was unavailable. A UPMC spokeswoman also declined comment.
At the heart of the lawsuit was the claim that between 2006 and 2016 UPMC offered bonuses of nearly 30% to surgeons who exceeded a base number of billable medical procedures, which were based on units of work. The arrangement resulted in questionable and unnecessary operations and other procedures that inflated consumer bills while enriching UPMC and the doctors, according to the lawsuit.
In 2009, for example, UPMC’s neurosurgery department was the “single highest grossing neurosurgical department in the United States, with Medicare charges alone of $58.6 million,” according to the lawsuit.
UPMC lawyers argued that its physician compensation method was created by Medicare and bonuses were an industry practice of rewarding doctors for productivity. Such arrangements were both lawful and commonly used, they said.
Writing for the 3rd Circuit, Judge Stephanos Bibas said the plaintiffs had presented credible evidence of wrongdoing and so the lawsuit should proceed.
Kris B. Mamula: firstname.lastname@example.org or 412-263-1699.
First Published September 18, 2019 8:04 AM