University of Pittsburgh Medical Center and Justice Department Settle Whistleblower Lawsuit

Photo: Pichsakul Promrungsee EyeEm/Getty Images

Dr. James Luketic, University of Pittsburgh Medical Center, and University of Pittsburgh Physicians settled with the U.S. government on a whistleblower lawsuit filed in September 2021 alleging fraudulent billing and unsafe surgical practices.

Luketic, UPMC, and UPP have agreed to pay $8.5 million to the Justice Department to settle a lawsuit based on a two-year investigation into allegations originally brought by Dr. Jonathan D’Cunha, a former UPMC surgeon.

In its complaint, the U.S. alleged that Luketic — longtime chairman of UPMC’s department of cardiothoracic surgery — routinely performed up to three complex surgical procedures at once, did not participate in all of the “key and critical” parts of his operations. , and forced his patients to endure hours of medically unnecessary anesthesia as he moved between operating rooms to attend to other patients or cases.

According to the complaint, these actions amounted to violations of statutes and regulations that forbid “doctor-educators” like Luketic from billing the United States for “simultaneous surgeries.”

In addition to the $8.5 million, the defendants also agreed to develop a corrective action plan for Luketic and conduct an annual independent review of Luketic’s Medicare physician bills.

UPMC, in turn, has the ability to request information, advice, and/or an advisory opinion from the Centers for Medicare and Medicaid Services regarding certain Medicare rules regarding the types of transactions considered in this case.

WHAT INFLUENCES

In June 2022, the court rejected the defendants’ attempt to dismiss the government’s complaint. According to the settlement agreement, this is neither an admission by the defendants of their responsibility, nor a concession to the United States that their claims are unfounded. Instead, the parties agreed to settle the case in order to avoid the delays and costs of protracted litigation.

The Justice Department called the False Claims Act “one of the most powerful tools in the United States’ ongoing efforts” to combat healthcare fraud.

BIG TREND

Settlements and judgments under the False Claims Act exceeded $2.2 billion in the fiscal year ended Sept. 30, more than $1.7 billion of which related to matters relating to the healthcare industry, including drug and medical device manufacturers, medical devices durables, home health care, and according to the Department of Justice, managed care providers, hospitals, pharmacies, hospice organizations, and physicians.

The False Claims Act imposes triple harm and penalties on those who knowingly and falsely demand money from the federal government or knowingly fail to pay money owed to the United States.

The amounts included in $1.7 billion reflect reimbursements for federal losses only. The Department of Justice said that in many of these cases, the department was instrumental in collecting additional amounts for state Medicaid programs.

The agency said the fiscal 2022 recovery also reflected the department’s focus on new enforcement priorities, including fraud in pandemic relief programs and alleged violations of cybersecurity requirements in government contracts and grants.

The Department of Justice was actively investigating potential healthcare-related fraud. This month alone, the agency indicted more than two dozen people for their alleged involvement in a wire fraud scheme that created illegal licensing and reduced employment opportunities for aspiring nurses.

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