Regulatory

Whistleblower suit accuses UPMC, lead surgeon of fraudulent billing tied to ‘concurrent surgeries’

by Dave Muoio | September 8, 2021

The U.S. has filed a whistleblower suit against the University of Pittsburgh Medical Center, its physician group and a department chair alleging fraudulent billing and surgical practices that threaten patient care, the Department of Justice announced last week.

The case is the product of a two-year investigation into allegations brought by a former UPMC physician under the False Claims Act, the DOJ said.

In it, federal prosecutors allege that James Luketich, M.D., chair of UPMC’s Department of Cardiothoracic Surgery, and the organizations knowingly submitted “hundreds” of false claims to government programs since 2015.

“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,” Special Agent in Charge Maureen R. Dixon of the HHS-OIG Philadelphia Regional Office said in a statement.

The feds allege that Luketich would regularly perform and bill for up to three complex surgeries simultaneously, often missing “key and critical” portions of the procedures and leaving patients unnecessarily sedated while moving between operating rooms or attending to other matters.

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Chris J. Stewart

Chris currently serves as President and CEO of Surgio Health. Chris has close to 20 years of healthcare management experience, with an infinity to improve healthcare delivery through the development and implementation of innovative solutions that result in improved efficiencies, reduction of unnecessary financial & clinical variation, and help achieve better patient outcomes. Previously, Chris was assistant vice president and business unit leader for HPG/HCA. He has presented at numerous healthcare forums on topics that include disruptive innovation, physician engagement, shifting reimbursement models, cost per clinical episode and the future of supply chain delivery.

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