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U.S. files suit against UPMC, surgeon, and physicians practice group for violating false claims act

PITTSBURGH — The United States on Thursday filed a complaint under the False Claims Act against UPMC, University of Pittsburgh Physicians and Dr. James Luketich, longtime chair of UPMC’s Department of Cardiothoracic Surgery.

The complaint was based on a two-year investigation into allegations brought by a former UPMC physician under the False Claims Act’s whistleblower provisions. The doctor alleged that they knowingly submitted hundreds of false claims for payment to Medicare, Medicaid, and other government health programs over the past six years.

The complaint also alleged that Luketich, who regularly performs as many as three complex surgical procedures at the same time, failed to participate in all the “key and critical” portions of his surgeries, and forced patients to endure hours of medically unnecessary anesthesia as he moved between operating rooms and to other patients.

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This violated the statutes and regulations governing the defendants, including those that prohibit “teaching physicians,” like Luketich, from performing and billing the United States for “concurrent surgeries,” according to the complaint.

Luketich is also accused of violating the standard of care and patients’ trust, and heightening the risk of serious complications, according to the complaint.

UPMC’s Vice President and Chief Communications officer Paul Wood said in a statement:

“Dr. James Luketich is a uniquely skilled and world-renowned cardiothoracic surgeon. As the government itself concedes in its Complaint:

Many of [Dr.] Luketich’s surgical patients are elderly, frail, and/or very ill. They include the ‘hopeless’ patients . . . who suffer from chronic illness or metastatic cancer, and/or have extensive surgical histories, and choose UPMC and [Dr.] Luketich when other physicians and healthcare providers have turned them down.

When treating these patients, Dr. Luketich leads teams of highly skilled surgeons and other clinicians through complex procedures that frequently last more than 12 hours. As the government also concedes, Dr. Luketich always performs the most critical portions of every operation he undertakes.

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. 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.”

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