番茄社区

The U.S. government has finalized a settlement agreement with the University of Pittsburgh Medical Center (UPMC) and University of Pittsburgh Physicians (UPP) as well as the organizations' star surgeon James Luketich, MD, regarding a false claims lawsuit involving concurrent surgeries.

As part of the settlement agreement, Luketich, UPMC, and UPP have agreed to pay $8.5 million to the federal government to resolve the claims against them, . The defendants have also agreed to create and put into effect a corrective action plan for the surgeon, and to submit to a year-long, third-party audit of his fee services billing to Medicare.

The settlement agreement follows the 2021 filing of a federal lawsuit that was based on a 2-year investigation into allegations originally brought by another former UPMC surgeon, the agency said. The federal government alleged in the suit that Luketich -- the longtime chair of UPMC's Department of Cardiothoracic Surgery -- performed as many as three complex surgeries at the same time, and that he failed to participate in all of the "key and critical" portions of the procedures. The feds further alleged that Luketich forced his patients to endure hours of medically unnecessary anesthesia time as he moved between operating rooms and other patients and matters.

According to the lawsuit, the alleged practices "amounted to violations of the statutes and regulations which prohibit 'teaching physicians' (like Dr. Luketich) from billing the United States for 'concurrent surgeries,' were well known to UPMC leadership, and increased the risk of surgical complications to patients," the DOJ stated.

番茄社区 has previously reported more broadly on the issues with concurrent surgeries and the federal government's increased scrutiny when it comes to hospitals double- or triple-booking top surgeons.

In the case of Luketich, UPMC, and UPP, the DOJ said the settlement agreement is neither an admission of liability by the defendants nor a concession by the federal government that its claims are not well founded. UPMC will have the ability to request information and guidance from the Centers for Medicare & Medicaid Services regarding certain Medicare regulations that pertain to the types of surgeries at issue in the case, the DOJ said.

"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," Troy Rivetti, acting U.S. Attorney for the Western District of Pennsylvania, said in a statement. "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."

Efrem Grail, legal counsel for Luketich, said the following in an emailed statement to 番茄社区: "We're pleased this settlement puts an end to the government's case. Medical schools and their hospitals have sought clarity about the billing regulation for teaching physicians at issue here for years, and the United States has 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."

As of press time, neither UPMC or UPP nor their legal counsel in the case had responded to request for comment.

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