U.S. accuses UPMC, leading surgeon of billing fraud

University of Pittsburgh Medical Center in Pittsburgh, Pennsylvania. REUTERS/ Jason Cohn
  • Surgeon accused of booking, billing for simultaneous surgeries
  • UPMC says case based on 'misapplication' of federal law

(Reuters) - The federal government has accused the University of Pittsburgh Medical Center and the head of its cardiothoracic surgery department of fraudulently billing Medicare and Medicaid for complex surgeries.

The complaint, filed Thursday in federal court in Pittsburgh, Pennsylvania, claims that UPMC has regularly allowed James Luketich to book as many as three complex surgeries at the same time, going back and forth between patients and not participating in key parts of the surgeries, while keeping patients under unnecessary anesthesia.

The government alleges Luketich and UPMC violated laws and regulations that they say prevent physicians like Luketich, who perform teaching duties within a medical school or residency program, from billing federal health insurance programs for such surgeries. It also alleges that the practice harmed patients.

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"The laws prohibiting 'concurrent surgeries' are in place for a reason: to protect patients and ensure they receive appropriate and focused medical care," Acting U.S. Attorney Stephen Kaufman of the Western District of Pennsylvania said in a statement. "Our office will take decisive action against any medical providers who violate those laws, and risk harm to Medicare and Medicaid beneficiaries."

"Dr. Luketich is confident that (the allegations) are wholly incorrect, and we will vigorously defend against them," Luketich's lawyer, Efrem Grail of The Grail Law Firm, said in an email. "Dr. Luketich enjoys a stellar reputation as a surgeon, as a person of integrity and as a doctor who cares."

UPMC spokesperson Paul Wood said that the case was based in a "misapplication or misinterpretation" of federal guidance, and that performing and billing for overlapping surgeries is not fraudulent.

The case began with a 2019 whistleblower lawsuit filed by a former UPMC doctor, Jonathan D'Cunha. The government exercised its power to intervene in the case under the False Claims Act.

The government alleged that, in addition to resulting in hundreds of fraudulent bills to government health insurance programs, Luketich's practices have resulted in serious harm to patients by extending their surgeries and time under anesthesia, increasing the risk of complications.

In January 2015, Jonas Johnson, the head of UPMC's Surgical Services Oversight Committee reprimanded Luketich following an incident in which he left a patient under anesthesia and could not be found for an hour, according to the complaint. Later that year, Johnson again warned Luketich that he could only provide services to one Medicare patient at a time, the complaint said.

Nonetheless, according to the complaint, Luketich continued to schedule and perform concurrent surgeries.

Luketich is one of UPMC's highest sources of revenue, the government said, bringing in tens of millions of dollars per year. It is seeking unspecified monetary damages.

The case is United States ex rel. D'Cunha v. Luketich et al, U.S. District Court, Western District of Pennsylvania, No. 2:19-cv-00495.

For the government: Assistant U.S. Attorney Adam Fisher of the Western District of Pennsylvania

For D'Cunha: Claire Sylvia of Phillips & Cohen

For Luketich: Efrem Grail of The Grail Law Firm

For UPMC: Jack Fernandez of Zuckerman Spaeder

(CORRECTION: The spelling of Phillips & Cohen has been corrected.)

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Brendan Pierson reports on product liability litigation and on all areas of health care law. He can be reached at brendan.pierson@thomsonreuters.com.