University of Pittsburgh Medical Center, DOJ settle whistleblower suit

Photo: Pichsakul Promrungsee EyeEm/Getty Images

Dr. James Luketich, University of Pittsburgh Medical Center and University of Pittsburgh Physicians have settled with the United States government over a whistleblower lawsuit brought in September 2021 that alleged fraudulent billing and unsafe surgical practices.

Luketich, UPMC and UPP have agreed to pay $8.5 million to the Department of Justice to settle a lawsuit that was 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 Luketich – the longtime chair of UPMC's Department of Cardiothoracic Surgery – regularly performed as many as three complex surgical procedures at the same time, failed to participate in all of the "key and critical" portions of his surgeries, and forced his patients to endure hours of medically unnecessary anesthesia time, as he moved between operating rooms and attended to other patients or matters.

According to the complaint, those practices amounted to violations of the statutes and regulations which prohibit "teaching physicians" like Luketich from billing the United States for "concurrent surgeries." 

In addition to the $8.5 million, the defendants also agreed to create a corrective action plan for Luketich, and to submit to a year-long, third-party audit of Luketich's physician fee services billings to Medicare.

UPMC, in turn, has the ability to request information, guidance and/or an advisory opinion from the Centers for Medicare and Medicaid Services regarding certain Medicare regulations pertaining to the types of surgeries at issue in the case.

WHAT'S THE IMPACT?

In June 2022, the court denied the defendants' attempt to dismiss the government's complaint. According to the settlement agreement, it's neither an admission of liability by the defendants nor a concession by the U.S. that its claims are not well founded. Instead, the parties agreed to resolve the case to avoid delay and the expense of protracted litigation.

The DOJ called the False Claims Act "one of the most powerful tools in the United States' continued efforts" to combat healthcare fraud.

THE LARGER TREND

Settlements and judgments under the False Claims Act exceeded $2.2 billion in the fiscal year that ended on September 30, more than $1.7 billion of which pertained to matters that involved the healthcare industry – including drug and medical device manufacturers, durable medical equipment, home health and managed care providers, hospitals, pharmacies, hospice organizations and physicians, according to the Department of Justice.

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

The amounts included in the $1.7 billion reflect recoveries arising just from federal losses. In many of these cases, the department was instrumental in recovering additional amounts for state Medicaid programs, the DOJ said.

The recoveries in fiscal year 2022 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 agency said.

The DOJ has been active in pursuing potential healthcare-related fraud. Just this month the agency charged more than two dozen people for their alleged participation in a wire fraud scheme that created an illegal licensing and employment shortcut for aspiring nurses.

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com