UPMC has agreed to an $8.5 million settlement to resolve a federal fraud case involving its head of cardiothoracic surgery.
In September 2021, the U.S. Department of Justice sued Dr. James Luketich, UPMC and the University of Pittsburgh Physicians for allegedly submitting false claims to Medicare and defrauding the federal government.
While physicians at teaching hospitals are permitted to perform multiple surgeries at the same time, Luketich was accused of not being immediately available during key portions of procedures. Attorneys for the Justice Department said the surgeon’s patients endured hours of medically unnecessary anesthesia time, putting them at risk of complications. Federal investigators say Luketich’s actions during these concurrent surgeries ran afoul of statutes and regulations in regard to billings.
“While UPMC continues to believe Dr. Luketich’s surgical practice complies with [Centers for Medicare & Medicaid Services] requirements; it has agreed to pay $8.5 million to the government to avoid the distraction and expense of further litigation,” said UPMC spokesman Paul Wood.
Luketich’s attorney Efrim Grail told WESA he was pleased with the outcome, and that it will hopefully lead to better guidance on medical bills: “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.”
The agreement is not an admission of guilt or liability by Luketich and his co-defendants. Nor is it a concession on behalf of the Justice Department, which says the settlement is a just conclusion to the investigation into Luketich and UPMC. The investigation began in 2019 after a whistleblower complaint filed by Dr. Jonathan D’Cunha, who left UPMC and now practices at Mayo Clinic’s Arizona campus.
“This Office is committed to safeguarding the Medicare and Medicaid programs, and to protecting those programs’ beneficiaries,” said Acting U.S. Attorney Troy Rivetti for the Western District of Pennsylvania. “No medical provider — however renowned — is excepted from scrutiny or above the law.”
As part of the agreement, Luketich will also have to submit to a year-long, third-party audit of his medical bill practices.
