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UPMC, UPP and cardiothoracic surgeon to pay $8.5 million for False Claims allegations

por John R. Fischer, Senior Reporter | March 08, 2023
Dr. James Luketich, UPMC and UPP will pay $8.5 million to settle False Claims allegations over billing for and performing multiple concurrent surgeries.
Cardiothoracic surgeon Dr. James Luketich, along with the University of Pittsburgh Medical Center and the University of Pittsburgh Physicians, will pay $8.5 million to settle False Claims allegations of billing Medicare for complex surgeries performed concurrently, that put patients at greater risk for surgical complications.

Former UPMC surgeon Dr. Jonathan D’Cunha filed a complaint against the three under the whistleblower provision of the False Claims Act, which allows private parties to file suits on behalf of the U.S. government in exchange for a portion of any recovery.

In United States of America ex rel. Jonathan D’Cunha, M.D. v. James Luketich. et al., No. 19-cv-495 (W.D. Pa.), D’Cunha says that Luketich, the longtime chair of UPMC’s department of cardiothoracic surgery, routinely performed as many as three, complex surgeries at the same time. Moving between operating rooms and attending to other patients caused Luketich to miss “key and critical” portions of the procedures and forced his patients to undergo hours of medically unnecessary anesthesia, while putting them at risk for complications, alleges D’Cunha.

Teaching physicians like Luketich are prohibited from billing the U.S. for concurrent surgeries, according to the complaint, which says that UPMC leaders were aware of his actions. Upon being filed, the suit led to a two-year investigation.

“The Settlement Agreement provides that UPMC will implement a corrective action plan for Dr. Luketich, and he will now have to undergo close scrutiny of his work,” said FBI Pittsburgh Special Agent in Charge Mike Nordwall, in a statement.

In addition to the corrective action plan, the defendants must submit a year-long, third-party audit of Luketich’s physician fee service billings to Medicare. UPMC can request information, guidance, assurance and an advisory opinion on certain Medicare regulations pertaining to the type of surgeries at issue, from CMS.

At one point, Luketich, UPMC and UPP requested the government’s complaint be dismissed, but the court denied this in June 2022. Both sides agreed to settle to avoid delay and expensive, protracted litigation.

The settlement is neither an admission of liability by the defendants nor a concession by the U.S. that its claims are not well founded.

Under the False Claims Act, the U.S. can choose to take over the case in its entirety, or partially, which it did in this matter.

Luketich, UPMC and UPP did not respond to a request for comment by press time.

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