UPMC, its chair of cardiothoracic surgery and University of Pittsburgh Physicians agreed to pay $8.5M to the Justice Department to resolve a whistleblower suit brought by a former UPMC physician.
Prosecutors alleged that the defendants illegally submitted hundreds of false claims to Medicare, Medicaid and other government health programs over a six-year period. James Luketich, MD, UPMC's longtime cardiothoracic chair, allegedly performed up to three complex surgeries at the same time, did not participate in "key and critical" portions of his cases and had patients under anesthesia for long periods as he moved between operating rooms, according to prosecutors.
The defendants have also agreed to create a corrective action plan for Dr. Luketich, and to submit to a yearlong, third-party audit of his physician fee services billings to Medicare.
An internal incident report from 2016 claimed two patients undergoing surgery by Dr. Luketich in separate operating rooms were left under general anesthesia with towels covering their surgical wounds, with no progress made in either case between 3 p.m. and 7 p.m., according to NBC affiliate WPXI. The report alleges a third operating room was prepared at 6 p.m. for another of Dr. Luketich's cases. He was unable to be reached by phone or via his clinic and eventually arrived in the post-anesthesia care unit at 6:45 p.m., the report alleged.
Several of Dr. Luketich's patients allegedly suffered complications as a result of these practices, including painful pressure ulcers, deep tissue injuries and amputations in at least two cases.
Federal law prohibits surgeons at teaching hospitals from billing CMS for two concurrent surgeries unless the surgeon is present for all "critical or key portions" of the procedure. Prosecutors also said breaking this law violates the standard of care, erodes patients' trust and increases the risk of serious complications.
The case was originally filed by Jonathan D'Cunha, MD, PhD, under the False Claims Act. Dr. D'Cunha was a former UPMC cardiothoracic surgeon who now practices at Mayo Clinic in Phoenix.
"This is an important settlement and a just conclusion to the United States’ investigation into Dr. Luketich's surgical and billing practices, and UPMC and UPP's acceptance of those practices," Acting U.S. Attorney Troy Rivetti said in a Feb. 27 news release. "This Office is committed to safeguarding the Medicare and Medicaid programs, and to protecting those programs’ beneficiaries. No medical provider — however renowned — is excepted from scrutiny or above the law."