The five counts filed against UPMC include three violations of the False Claims Act, unjust enrichment, and payment by mistake. (Photo: Erika J. Mitchell/Shutterstock.com) The University of Pittsburgh Medical Center, its physician practice group, and the chairman of the cardiothoracic surgery department were sued by the federal government for allegedly filing false claims for payment to Medicare and Medicaid over a six-year period.
The U.S. Attorney's Office for the Western District of Pennsylvania announced the filing of the 47-page complaint Sept. 2, which details five counts against UPMC, including three violations of the False Claims Act, unjust enrichment, and payment by mistake.
According to the complaint, UPMC allowed Dr. James Luketich "to book and perform three surgeries at the same time, to miss the surgical time outs at the outset of those procedures, to go back-and-forth between operating rooms and even hospital facilities while his surgical patients remain under general anesthesia, to leave those anesthetized patients for hours at a time while he attends to other matters, to falsely attest that he was with his patients throughout the entirety of their surgical procedures or during all 'key and critical' portions of those procedures, and to unlawfully bill Government Health Benefit Programs for those procedures, all in order to increase surgical volume, maximize UPMC and UPP's revenue, and/or appease Luketich."
The complaint said that the violations illustrated practices that "defy the standard of care, abuse patients' trust, inflate anesthesia time, increase the risk of complications to patients, and—on at least several occasions during the claims period—have resulted in serious harm to patients. Indeed … some of Luketich's patients were forced to endure additional surgical procedures and/or extended hospital stays as a result of his unlawful conduct. Numerous patients developed painful pressure ulcers. A few were diagnosed with compartment syndrome. And at least two had to undergo amputations."
In response to the government's allegations, UPMC stood by Luketich.
"No law or regulation prohibits overlapping surgeries or billing for those surgeries, let alone surgeries conducted by teams of surgeons like those led by Dr. Luketich," spokesman Paul Wood said in an emailed statement. "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. UPMC and Dr. Luketich plan to vigorously defend against the government's claims."
Luketich's attorney, Efrem Grail of The Grail Law Firm, said that, with regard to the improper billing allegations, his client "is confident that they are wholly incorrect, and we will vigorously defend against them."
"Dr. Luketich enjoys a stellar reputation as a surgeon, as a person of integrity and as a doctor who cares," Grail said in a statement.
Prosecutors alleged that UPMC ignored or minimized staff complaints about Luketich's "hyper-busy" schedule since 2015, protected him from "meaningful sanction," and refused to curtail his surgical practice.
"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 said in the government's announcement Thursday. "Our office will take decisive action against any medical providers who violate those laws, and risk harm to Medicare and Medicaid beneficiaries."
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