$8.5M Settlement Reached With Surgeon And Others: It was announced on February 27, 2023 that the United States has finalized a Settlement Agreement with James L. Luketich, M.D., University of Pittsburgh Medical Center (“UPMC”), and University of Pittsburgh Physicians (“UPP”), to resolve the lawsuit the United States filed against those Defendants in September 2021.
The United States’ lawsuit was filed under the False Claims Act, 31 U.S.C. 3729, et seq., and was based on a two-year investigation into allegations originally brought by Jonathan D’Cunha, M.D., a former UPMC surgeon. In its Complaint, the United States alleged that Dr. Luketich – the longtime chair of UPMC’s Department of Cardiothoracic Surgery – regularly performed as many as three, complex surgical procedures at the same time, failed to participate in all of the “key and critical” portions of his surgeries, and forced his patients to endure hours of medically unnecessary anesthesia time, as he moved between operating rooms and attended to other patients or matters. According to the United States’ Complaint, those practices amounted to violations of the statutes and regulations which prohibit “teaching physicians” (like Dr. Luketich) from billing the United States for “concurrent surgeries,” were well known to UPMC leadership, and increased the risk of surgical complications to patients.
As part of that Settlement Agreement, Dr. Luketich, UPMC, and UPP agreed to pay $8.5 million to the United States to resolve the claims against them. The Defendants also agreed to create and effectuate a Corrective Action Plan for Dr. Luketich, and to submit to a year-long, third-party audit of Dr. Luketich’s physician fee services billings to Medicare. Pursuant to the Settlement Agreement, UPMC, in turn, has the ability to request information, guidance, assurance and/or an advisory opinion from the Centers for Medicare and Medicaid Services of the Department of Health and Human Services regarding certain Medicare regulations pertaining to the types of surgeries at issue in the case.
In June 2022, the Court denied the Defendants’ attempt to dismiss the Government’s Complaint. The Settlement Agreement provides that it is neither an admission of liability by the Defendants nor a concession by the United States that its claims are not well founded. Instead, in order to avoid delay and the expense of protracted litigation, and in consideration of the promises and obligations of the Settlement Agreement, the parties agreed to resolve the case.
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publicly known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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