The U.S. Department of Justice (DOJ) has alleged that the University of Pittsburgh Medical Center in Pennsylvania (UPMC) and the head of cardiothoracic surgery, James Luketich, “fraudulently bill[ed] Medicare and Medicaid for complex surgeries,” according to court documents.  The complaint was filed this month in federal court in Pittsburgh, Pennsylvania, after an investigation began following a 2019 whistleblower lawsuit submitted by former UPMC physician, Jonathan D’Cunha.  The government intervened under the False Claims Act, which allows it to step in and hold liable persons and companies who defraud governmental programs.The Department of Justice (DOJ) said, “PMC has regularly allowed James Luketich to book as many as three complex surgeries at the same time, going back and forth between patients and not participating in key parts of the surgeries, while keeping patients under unnecessary anesthesia.”  Furthermore, “Luketich and UPMC violated laws and regulations that they say prevent physicians like Luketich, who perform teaching duties within a medical school or residency program, from billing federal health insurance programs for such surgeries.”

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Juggling multiple surgeries at once is extremely dangerous to patients.  Acting U.S. Attorney Kaufman added, “The laws prohibiting ‘concurrent surgeries’ are in place for a reason: to protect patients and ensure they receive appropriate and focused medical care.  Our office will take decisive action against any medical providers who violate those laws, and risk harm to Medicare and Medicaid beneficiaries.”Doing so also suggests that the doctor and center are more concerned about profits than patient care.  Special Agent in Charge Maureen R. Dixon of the HHS-OIG Philadelphia Regional Office added, “When physicians and other healthcare providers put financial gain above patient well-being and honest billing of government healthcare programs, they violate the basic trust the public extends to medical professionals.  Our agency, working closely with our law enforcement partners, will continue to thoroughly investigate such healthcare fraud allegations to protect the health of patients and the integrity of taxpayer-supported programs serving them.”“Doctors take an oath to uphold the highest levels of ethical standards and care,” explained FBI Pittsburgh Special Agent in Charge Mike Nordwall. “The allegations set forth today violate those ethics, painting a picture of fraud and deception.  The FBI will continue to investigate fraud in our health care system and hold those accountable to face the consequences of their actions.”UPMC spokesperson Paul Wood argued that the government’s case was misguided.  He said the case was based on a “misapplication or misinterpretation of federal guidance,” and that “performing and billing for overlapping surgeries is not fraudulent.”However, Luketich has a history of endangering his patients.  In January 2015, he was reprimanded after he left a patient under anesthesia and could not be found for at least an hour.  Later that same year, he was again issued a warning that he could only provide services to one Medicare patient at a time.  “Nonetheless,” according to the complaint, “Luketich continued to schedule and perform concurrent surgeries.”“Luketich is one of UPMC’s highest sources of revenue,” the government said, “bringing in tens of millions of dollars per year,” which is a good reason for the facility to protect the doctor’s poor decision-making.   The DOJ is seeking unspecified monetary compensation.

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U.S. accuses UPMC, leading surgeon of billing fraudUnited States Files Suit Against UPMC, Its Physician Practice Group, and the Chair of Its Department of Cardiothoracic Surgery for Violating the False Claims Act