Hospitals throw support behind UPMC in battle with feds

Hospitals across the nation are expressing support for UPMC as the Pittsburgh-based system urges a Pennsylvania federal court to toss allegations that it submitted false claims to government payers for concurrent surgeries performed by one of its top surgeons.

The Justice Department filed a False Claims Act complaint in September against UPMC, its physician practice group and James Luketich, MD, the longtime chair of its department of cardiothoracic surgery. The complaint alleges Dr. Luketich regularly performs as many as three complex surgical procedures at the same time and fails to participate in some of the "key and critical" portions of the surgeries. The alleged practices violate statutes and regulations prohibiting teaching physicians from performing and billing the government for concurrent surgeries, the Justice Department argues. 

UPMC and Dr. Luketich are defending against the government's claims. They're urging the court to nix the suit, arguing Nov. 1 that there are no regulations prohibiting surgeons from conducting concurrent surgeries, according to Law360.  

The American Hospital Association, which includes nearly 5,000 hospitals, systems and providers, and the more than 240 hospitals and systems that are part of the Hospital and Healthsystem Association of Pennsylvania are supporting UPMC in it's legal battle. 

In a friend-of-the-court brief filed Nov. 1, the hospital groups argue federal billing guidance "explicitly allows doctors to determine what portions of particular surgeries are 'critical,' and permits overlapping surgeries to occur so long as a qualified backup physician is available." The surgeries led by Dr. Luketich were conducted by teams of surgeons, a UPMC spokesperson told the Pittsburgh Post-Gazette in October. 

The billing guidance cited in the brief has allowed hospitals to develop policies for overlapping and concurrent surgeries that are consistent with guidance from the American College of Surgeons, the hospital groups say.

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