UPMC, Star Surgeon Sued For Fraud Due to Alleged Overlapping Surgeries

The U.S. government and a former University of Pittsburgh Medical Center (UPMC) physician have filed a lawsuit against UPMC and one of its standout surgeons after they allegedly charged CMS programs and the VA full freight for procedures that the surgeon only partially conducted, the Department of Justice (DOJ) reported.

UPMC and its physician practice group, the University of Pittsburgh Physicians (UPP), along with James Luketich, MD, chair of the cardiothoracic surgery department at the University of Pittsburgh School of Medicine, have been charged with three counts of violating the False Claims Act, unjust enrichment, and payment by mistake, according to the lawsuit filed in the U.S. Court for the Western District of Pennsylvania last week.

Based on a 2-year investigation, the complaint alleged that they “knowingly submitted hundreds of materially false claims for payment to Medicare, Medicaid, and other government health benefit programs over the past six years,” according to a DOJ press release.

Co-plaintiff Jonathan D’Cunha, MD, PhD, another cardiothoracic surgeon, “worked closely with, and regularly observed, Luketich” from 2012 to 2019 at UPMC as a UPP contractor, the suit stated. D’Cunha now works at the Mayo Clinic in Phoenix, but his bio indicates that he served on a UPMC committee until this year.

The government is seeking retribution of three times the amount the system billed the public programs, and at least $23,331 for each procedure under question. It has requested a jury trial.

The lawsuit alleged that Luketich often staggered three surgeries, booking two adjacent rooms for the same time and then starting another nearby, which is “typically booked under another attending physician’s name” because he cannot legally manage more than two at once.

UPMC has “knowingly allowed” Luketich to “miss the surgical time outs at the outset of those procedures, to go back-and-forth between operating rooms and even hospital facilities while his surgical patients remain under general anesthesia, to leave those anesthetized patients for hours at a time while he attends to other matters,” the lawsuit continued.

It also alleges that UPMC allowed Luketich “to falsely attest that he was with his patients throughout the entirety of their surgical procedures or during all ‘key and critical’ portions of those procedures, and to unlawfully bill Government Health Benefit Programs for those procedures, all in order to increase surgical volume, maximize UPMC and UPP’s revenue, and/or appease Luketich.”

UPMC billed for each surgery as if Luketich were leading or co-fostering each one. The system paid him more than $2.4 million annually from 2017 to 2019. UPMC has also touted Luketich in advertisements and other marketing materials to attract more patients.

Luketich and UPMC colleagues “regularly sacrificed patient health in order to increase surgical volume in the CT Department, to ensure that Luketich — and only Luketich — performs certain portions of surgical procedures, and to maximize profit,” the lawsuit stated.

Luketich was warned to stop overbooking himself via internal communications, including directives from a UPMC surgery oversight committee.

“UPMC has persistently ignored or minimized complaints by employees and staff” about Luketich’s work habits, and “protected him from meaningful sanction; refused to curtail his surgical practice; and continued to allow Luketich to skirt the rules and endanger his patients,” according to the lawsuit.

“Some of Luketich’s patients were forced to endure additional surgical procedures and/or extended hospital stays as a result of his unlawful conduct. Numerous patients developed painful pressure ulcers. A few were diagnosed with compartment syndrome,” the suit continued.

In an email to MedPage Today, a UPMC spokesperson wrote, “as the government itself concedes in its complaint, many of Luketich’s surgical patients are elderly, frail, and/or very ill. They include the ‘hopeless’ patients … who suffer from chronic illness or metastatic cancer, and/or have extensive surgical histories, and choose UPMC and Luketich when other physicians and healthcare providers have turned them down. When treating these patients, Dr. Luketich leads teams of highly skilled surgeons and other clinicians through complex procedures that frequently last more than 12 hours.”

“Luketich always performs the most critical portions of every operation he undertakes,” the spokesperson added. “The government’s claims are, rather, based on a misapplication or misinterpretation of UPMC’s internal policies and CMS guidance, neither of which can support a claim for fraudulent billing.”

Luketich could not be reached through his attorney.

Neither D’Cunha nor Mayo Clinic responded to a query by press time. The Phillips & Cohen law firm, which is representing D’Cunha, declined to comment.

Luketich is an editorial board member for the Annals of Surgery, the Journal of Thoracic and Cardiovascular Surgery, and the Journal of Gastrointestinal Surgery, according to his UPMC “Experts” page. He is also an American College of Surgeons fellow. He continues to accept patients, according to his bio.