Whistleblower Lawsuit Alleges Fraudulent Billing Over Concurrent Surgeries at UPMC

The United States Department of Justice (DOJ) recently filed a whistleblower lawsuit against the University of Pittsburgh Medical Center, a department chair and the university’s physician group.

The lawsuit stems from allegations made by a former UPMC physician under the False Claims Act. The DOJ investigated the claims for two years after the whistleblower alleged the defendants were engaged in fraudulent billing and various surgical practices that threatened patient care.

Case background

The DOJ claims Dr. James Luketich, the chair of UPMC’s Department of Cardiothoracic Surgery, and the other organizations submitted hundreds of false claims to federal healthcare programs since 2015.

According to the suit, Luketich would perform and bill for up to three complex surgeries at the same time, while often missing critical portions of the procedures and leaving patients sedated unnecessarily while attending to other matters or moving between operating rooms.

These actions violate a wide range of regulations and statutes, including rules that prohibit billing for concurrent surgeries. The practices can also significantly increase risks of serious surgical complications, thus violating the overall standard of care and damaging the trust patients can have in their medical providers.

UPMC defended Luketich as a skilled and renowned surgeon, and all defendants said they intend to “vigorously” defend themselves against the allegations brought forth in the lawsuit.

The complaint alleges Luketich is a major source of profits for UPMC, bringing in millions of dollars of revenue to the program.

For more information about what to do if you uncover incidents of healthcare fraud, contact an experienced whistleblower attorney at Kardell Law Group.