Following a 2-year investigation, the US government has brought a lawsuit against the University of Pittsburgh Medical Center (UPMC), University of Pittsburgh (UPP) physicians and James Luketich, MD, for billing related to concurrent surgeries performed by the longtime physician chair of cardiothoracic surgery.
The lawsuit alleges that UPMC “knowingly allowed” Luketich to “book and perform three surgeries at the same time, to miss surgical downtime at the start of these procedures, to go back and forth between operating rooms and even hospital facilities while its surgical patients remain under general anesthesia… “
The UPMC, according to the lawsuit, also allowed Luketich to falsely certify that “he was with his patients throughout their surgeries or during all” key and critical “parts of those procedures, and to charge illegally government health benefit programs for these procedures, all with the goal of increasing surgical volume, maximizing UPMC and UPP revenue, and / or appeasing Luketich. “
These practices violate laws and regulations governing defendants, including those that prohibit “teaching physicians” like Luketich from performing and billing the United States for concurrent surgeries, the Department of Justice said in a press release. .
The Justice Department maintains that the defendants “have knowingly submitted hundreds of materially false claims” to Medicare, Medicaid and other government programs over the past 6 years.
“Laws banning ‘simultaneous surgeries’ are in place for a reason: to protect patients and ensure they receive appropriate and targeted medical care,” said Stephen R. Kaufman, Acting US District Attorney for the Western District of Pennsylvania, in the press release.
According to the lawsuit, “some of Luketich’s patients were forced to undergo additional surgeries and / or extended hospital stays due to his illegal conduct. Many patients developed painful pressure sores. A few were diagnosed with compartment syndrome. And at least two had to undergo amputations. “
The allegations were originally made under the false claims provisions of the Federal Whistleblower Act by Jonathan D’Cunha, MD, PhD, who worked closely with Luketich from 2012 to 2019 and now chairs the Department of Surgery Cardiothoracic from the Mayo Clinic in Phoenix, Arizona.
The charges cited in the lawsuit include three counts of violating the False Claims Act, one count of unjust enrichment and one count of payment in error.
The 56-page trial includes many case examples and cites an October 2015 Boston Globe Spotlight team report on the safety of performing concurrent operations, which would have prompted UPMC to re-evaluate its policies and identify any physicians or departments in potential breach.
Hospital officials met Luketich in March 2016 and drew up a “plan” to ensure his availability and “respect for competition rules,” he alleges, but also highlights an email that notes “lingering problems” with Luketich’s schedule.
“The UPMC has consistently ignored or downplayed complaints from employees and staff about Luketich, his overloaded schedule, his refusal to delegate surgeries and surgical tasks” and “protected him from significant sanction; refused to restrict his surgical practice; and continued to allow Luketich to bend the rules and put his patients at risk, ”according to the lawsuit.
The lawsuit notes that Luketich is one of the UPMC’s and the UPP’s most important sources of income, and that UPMC is portraying him as a “life-saving pioneer” who regularly performs dramatic procedures and last minute on patients who are otherwise desperate.
In response to an interview request from theheart.org | Cardiology Medscape, a spokesperson for UPMC wrote: “As the government itself acknowledges in its complaint, many surgical patients in Luketich are elderly, frail and / or very ill. / or have an extensive surgical history and choose UPMC and Luketich when other doctors and healthcare providers have refused them. “
“Dr Luketich always performs the most critical parts of every operation he undertakes,” the spokesperson said, adding that no law or regulation prohibits the overlapping of surgeries or the billing of these surgeries, ” not to mention surgeries carried out by teams of surgeons like those led by Luketich. “
Rather, the government’s claims are based on a misapplication or misinterpretation of the UPMC’s internal policies and [Centers for Medicare & Medicaid Services] advice, none of which can support a fraudulent billing claim. The UPMC and Dr Luketich plan to vigorously defend themselves against the government’s claims, ”the spokesperson concluded.
The claims made against the defendants are only allegations; there was no determination of responsibility. The government is claiming three times the amount of the actual damages suffered as a result of the false and / or fraudulent allegations; an amount of $ 23,331 (or the maximum penalty, whichever is greater) for each false claim submitted by UPMC, UPP and / or Luketich; and the costs and expenses associated with the civil action.