Channel Sponsor - Coding/Billing/Collections

Sponsored by National Medical Billing Services | info@nationalASCbilling.com | (636) 273-6711

Whistleblower suit against UPMC, physician group will proceed, judge rules

A federal judge rejected the University of Pittsburgh Medical Center's bid to dismiss a whistleblower lawsuit against UPMC, its physicians group and its chair of cardiothoracic surgery, NBC affiliate WPXI reported July 7.

The defendants are accused of submitting hundreds of false claims to Medicare, Medicaid and other government health programs over a six-year period. 

The Justice Department alleges UPMC and James Luketich, MD, chair of cardiothoracic surgery at the medical center, "regularly sacrificed patient health in order to increase surgical volume" and "maximize profit," according to the report. 

Dr. Luketich allegedly performs up to three complex surgeries at the same time, does not participate in "key and critical" portions of his cases and has patients under anesthesia for long periods as he moves between operating rooms, the Justice Department said

An internal incident report from 2016 claimed two patients undergoing surgery by Dr. Luketich in separate operating rooms were left under general anesthesia with towels covering their surgical wounds, with no progress made in either case between 3 and 7 p.m., according to the report. The report alleges a third operating room was prepared at 6 p.m. for another of Dr. Luketich's cases. He was unable to be reached by phone or via his clinic and eventually arrived in the post-anesthesia care unit at 6:45 p.m., the report alleged. 

Several of Dr. Luketich's patients allegedly suffered complications as a result of these practices, including painful pressure ulcers, deep tissue injuries and amputations in at least two cases.

Federal law prohibits surgeons at teaching hospitals from billing CMS for two concurrent surgeries unless the surgeon is present for all "critical or key portions" of the procedure. Prosecutors also said breaking this law violates the standard of care, erodes patients' trust and increases the risk of serious complications. 

Defendants argued the government has not and cannot allege that another qualified physician was not present during those surgeries. The case was originally filed by Jonathan D'Cunha, MD, PhD, under the False Claims Act. Dr. D'Cunha was a former UPMC cardiothoracic surgeon who now practices at Mayo Clinic in Phoenix.

In her denial of UPMC's motion to dismiss the case, the judge quoted the Court of Appeals in another case: "With all this smoke, a fire is plausible. So this case deserves to go to discovery."

UPMC did not respond to Becker's request for comment.

Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

 

Featured Webinars

Featured Whitepapers

Featured Podcast