UPMC Top Doc Filed False Medicare Claims: U.S. Government

Pittsburgh PA

02 September, 2021

3:10 PM

Description

PITTSBURGH, PA — A top UPMC physician submitted hundreds of false claims to Medicare, Medicaid and other government health benefit programs over the past six years, according to a complaint filed by the federal government. The complaint alleges that Dr. James Luketich, longtime chair of UPMC's Department of Cardiothoracic Surgery, regularly performed as many as three complex surgical procedures at the same time and doesn't participate in all key and critical portions of his surgeries. Additionally, Luketich forced patients to endure hours of medically unnecessary anesthesia time so he could move between operating rooms or attend to other matters, according to court documents. "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 R. Kaufman said. "Our office will take decisive action against any medical providers who violate those laws, and risk harm to Medicare and Medicaid beneficiaries." The complaint, filed under the False Claims Act's whistleblower provisions following a two-year investigation, also names UPMC and UPMC Physicians. UPMC spokesman Paul Wood said no law or regulation prohibits overlapping surgeries or billing for those surgeries, let alone surgeries conducted by teams of surgeons like those led by Luketich. "The government's claims are, rather, based on a misapplication or misinterpretation of UPMC's internal policies and CMS guidance, neither of which can support a claim for fraudulent billing," Wood said. "UPMC and Dr. Luketich plan to vigorously defend against the government's claims. FBI Pittsburgh Special Agent in Charge Mike Nordwal noted that doctors take an oath to uphold the highest levels of ethical standards and care. "The allegations set forth today violate those ethics, painting a picture of fraud and deception," Nordwal said. "The FBI will continue to investigate fraud in our health care system and hold those accountable to face the consequences of their actions." Be the first to know what's happening in your community and region. With a free Patch subscription, you'll always be up to date on local and state news: https://patch.com/subscribe.