UPMC, surgeon to pay $8.5M to settle false claims allegations

PITTSBURGH (KDKA) - UPMC, the University of Pittsburgh Physicians and a surgeon agreed to pay $8.5 million to settle a lawsuit over false claim allegations.

The United States filed a lawsuit after a former UPMC surgeon alleged Dr. James Luketich, the longtime chair of UPMC's Department of Cardiothoracic Surgery, regularly performed up to three complex surgical procedures at the same time, failing to participate in all of the "key and critical" portions of his surgeries and forcing patients to endure hours of unnecessary anesthesia time as he moved between operating rooms.

According to the United States' complaint, those practices violated statutes and regulations that prohibit "teaching physicians" like Luketich from billing the United States for "concurrent surgeries." Prosecutors claimed the violations were known by UPMC leadership and increased the risk of surgical complications to patients.   

As a part of the settlement agreement, UPMC, UPP and Luketich agreed to create a corrective action plan and to submit a year-long, third-party audit of Luketich's physician fee services billings to Medicare. 

UPMC released a statement saying the allegations were made for some of Luketich's "most complicated, team-based surgical procedures" and that the parties agreed UPMC could seek clarity from the Centers for Medicare and Medicaid Services for how those surgeries should be billed.

"While UPMC continues to believe Dr. Luketich's surgical practice complies with CMS's requirements, it has agreed to pay $8.5 million to the government to avoid the distraction and expense of further litigation. UPMC has also reserved the right to challenge the relator's share of the settlement," the statement said in part. 

Lukitech's counsel also released a statement saying medical schools and their hospitals have looked for clarity about billing for teaching physicians but the U.S. never provided it. 

"This settlement provides a mechanism we hope will lead to authoritative guidance so that universally respected surgeons like Dr. Luketich can return their focus to training young doctors to save lives without having to put up with baseless claims of fraud," the statement said.