Under federal rules, Medicare will not pay for surgeries where the critical portions occur at the same time, or during what is called “concurrent surgery.” They must also be “immediately available” during the entire procedure, which means “not performing another procedure,” the government wrote. Under Medicare rules, at teaching hospitals, which include UPMC, a teaching physician is required to be in the operating room during “critical portions” of the procedure, the complaint said. It said that UPMC “regularly sacrificed patient health in order to increase surgical volume.”
He also is one of UPMC’s most active surgeons, performing or assisting on hundreds “and sometimes thousands” of procedures per year, generating tens of millions of dollar in revenue for the hospital system, the government said. Luketich, 68, is one of UPMC’s highest-paid employees, earning more than $2.4 million annually from 2017 to 2019, the complaint said. Even more, it continued, UPMC’s leadership held him out to the public as a global leader in minimally invasive surgical procedures. The civil action, which could result in fines and damages, alleges “longstanding, knowing and egregious violations of the public trust and patient rights.”Īccording to the complaint, UPMC ignored Luketich’s practices “for years” and allowed them to continue while protecting him from any meaningful sanctions. It follows on the heels of an initial whistleblower complaint filed by D’Cunha in April 2019 that remained under seal. The lawsuit also names University of Pittsburgh Physicians as a defendant. The complaint said he worked closely with Luketich. D’Cunha was employed by UPMC from 2012 to 2019 and served as the surgical director of lung transplantation. Jonathan D’Cunha, who is now the chair of cardiothoracic surgery at the Mayo Clinic in Phoenix. The complaint was filed by both the United States and Dr. Luketich plan to vigorously defend against the government’s claims.” 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. “No law or regulation prohibits overlapping surgeries or billing for those surgeries, let alone surgeries conducted by teams of surgeons like those led by Dr. Luketich always performs the most critical portions of every operation he undertakes. Luketich leads teams of highly skilled surgeons and other clinicians through complex procedures that frequently last more than 12 hours,” Wood said. Paul Wood, a spokesman for UPMC, said Luketich is a “uniquely skilled and world-renowned cardiothoracic surgeon.” As the government conceded in the complaint, Wood continued, his patients include very ill, elderly and frail people who choose UPMC and Luketich because others have turned them down.
Luketich did anything improper, and those patients, I think, would all say they owe their good health, if not their life, to his care,” Grail said. “We absolutely, categorically deny that Dr. “Our office will take decisive action against any medical providers who violate those laws, and risk harm to Medicare and Medicaid beneficiaries.”Īttorney Efrem Grail, who represents Luketich, denied the allegations. “The laws prohibiting ‘concurrent surgeries’ are in place for a reason: to protect patients and ensure they receive appropriate and focused medical care,” said Acting U.S. The 47-page complaint alleges at least two of Luketich’s patients had to undergo amputations because of his actions, including one person who lost portions of a hand and one who lost their lower leg. James Luketich include that he regularly performed as many as three complex surgical procedures at the same time - having to move between operating rooms and sometimes hospitals - forcing patients to have to endure additional hours of anesthesia and develop complications. The federal government on Thursday filed a civil complaint against UPMC, its longtime head of cardiothoracic surgery and a physicians group, accusing them of knowingly submitting hundreds of false claims to Medicare, failing to follow medical standards for surgery and knowingly putting patients at risk.
0 kommentar(er)
