UPMC defends surgery practices in battle with feds

UPMC is defending its surgery and billing practices after the Justice Department filed a false claims complaint against the Pittsburgh-based system, its physician group and the chair of its department of cardiothoracic surgery.

The complaint, announced Sept. 2, alleges the defendants submitted hundreds of false claims to Medicare, Medicaid and other government payers over the past six years. The complaint is based on a two-year investigation into allegations brought under the qui tam, or whistleblower provision, of the False Claims Act by a former UPMC physician. 

Prosecutors allege James Luketich, MD, longtime chair of UPMC's department of cardiothoracic surgery, 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. 

Prosecutors argue Dr. Luketich's alleged practices violate statutes and regulations prohibiting teaching physicians from performing and billing the government for concurrent surgeries. They further contend that his alleged practices violate the standard of care and heighten the risk of serious complications. 

UPMC and Dr. Luketich plan to defend against the government's claims. 

"No law or regulation prohibits 'concurrent' or 'overlapping' surgeries or billing for those surgeries, let alone surgeries conducted by teams of surgeons like those led by Dr. Luketich," a UPMC spokesperson told the Pittsburgh Post-Gazette

The spokesperson said the Justice Department's claims are based on "misapplication or misinterpretation" of the health system's internal policies and CMS guidance, according to the Oct. 9 Post-Gazette report. 

Read the full Post-Gazette article here.

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