Hospital, top surgeon accused of Medicare/Medicaid billing fraud

Hospital, top surgeon accused of Medicare/Medicaid billing fraud | Insurance Business America

Hospital, top surgeon accused of Medicare/Medicaid billing fraud

The federal government has accused a hospital and its head of cardiothoracic surgery of fraudulently billing Medicare and Medicaid for surgeries.

The government’s complaint, filed Thursday in federal court in Pittsburgh, claims that the University of Pennsylvania Medical Center (UPMC) regularly allowed Dr. James Luketich to book as many as three complex surgeries at the same time, according to a Reuters report. The complaint alleges that Luketich would go back and forth between patients and not participate in key parts of the surgery, all while keeping patients under unnecessary anesthesia.

The government said that Luketich and UPMC violated laws and regulations meant to prevent physicians like Luketich, who perform teaching duties in a medical school or residency program, from billing federal health insurance programs for such surgeries, Reuters reported. The government also claimed that the practice harmed patients.

“The laws prohibiting ‘concurrent surgeries’ are in place for a reason – to protect patients and ensure they receive appropriate and focused medical care,” said Stephen Kaufman, acting US attorney for the Western District of Pennsylvania. “Our office will take decisive action against any medical providers who violate those laws and risk harm to Medicare and Medicaid beneficiaries.”

Luketich denied the charges.

“Dr. Luketich is confident that [the allegations] are wholly incorrect, and we will vigorously defend against them,” Luketich’s attorney, Efrem Grail, said in an email to Reuters. “Dr. Luketich enjoys a stellar reputation as a surgeon, as a person of integrity and as a doctor who cares.”

UPMC spokesperson Paul Wood told Reuters that the government’s case was based on a “misapplication or misinterpretation” of federal guidelines, and that performing and billing for concurrent surgeries wasn’t fraudulent.

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The case began with a whistleblower lawsuit filed in 2019 by Jonathan D’Cunha, a former UPMC doctor, Reuters reported. The government used its powers under the False Claims Act to intervene in the case. The government alleged that, in addition to sending hundreds of fraudulent bills to Medicare and Medicaid, Luketich’s practices have caused serious harm to patients by extending their surgeries and time under anesthesia, increasing their risk of complications, Reuters reported.

According to the complaint, Luketich was reprimanded in 2015 by Jonas Johnson, head of UPMC’s Surgical Services Oversight Committee, following an incident in which he left a patient under anesthesia and couldn’t be found for an hour. The same year, Johnson again warned Luketich that he could only provide services to one Medicare patient at a time, Reuters reported.

Despite these warnings, Luketich continued to schedule and perform concurrent surgeries, Reuters reported.