UPMC plans “to vigorously defend” a lawsuit brought by the fed against the health system, its head of cardiothoracic surgery and physicians group — accusing them of knowingly submitting hundreds of false claims to Medicare; for failing to follow medical standards for surgery and knowingly putting patients at risk.
The case centers on star surgeon Dr. James Luketich, who runs the giant medical provider’s cardiothoracic care unit.
He is known for tackling difficult surgeries that other doctors wouldn’t touch, a practice that was touted in a UPMC television advertisement featuring the celebrated practitioner, the Post-Gazette reports.
But a rare U.S. Justice Department lawsuit against the surgeon and UPMC, alleging that he unlawfully billed the government when he performed multiple surgeries at the same time and severely harmed patients in the process, stunned national experts who say such cases have largely disappeared since a scandal unfolded in Boston over a similar case in 2015.
UPMC spokesman Paul Wood said in an emailed statement to the newspaper that the institution and Dr. Luketich “plan to vigorously defend against the government’s claims,” and that “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.”
Mr. Wood said the “government’s claims are, rather, based on a misapplication or misinterpretation of UPMC’s internal policies and [Centers for Medicare & Medicaid Services] guidance, neither of which can support a claim for fraudulent billing.” Read more.
