Dive Brief:
- The University of Pittsburgh Medical Center and James Luketich, the longtime chair of UPMC’s cardiothoracic surgery department, have agreed to pay $8.5 million to settle claims that the doctor and system jeopardized patient health to maximize profit and falsely billed federal programs.
- The whistleblower suit alleges that Luketich regularly performed as many as three complex surgeries at the same time, didn’t participate in critical portions of his procedures and kept patients under anesthesia for hours more than medically necessary.
- The Department of Justice, which intervened in the suit, also alleges that UPMC knowingly allowed Luketich to continue these practices to increase surgical volume and maximize UPMC’s revenue. Luketich is one of UPMC’s highest-paid employees, and one of UPMC’s highest sources of revenue, according to the lawsuit.
Dive Insight:
The whistleblower lawsuit was originally filed in 2019 by Jonathan D’Cunha, the current chair of cardiothoracic surgery at Mayo Clinic in Arizona, and formerly the vice chair of cardiothoracic surgery at UPMC. D’Cunha filed the suit after his complaints to UPMC administrators and medical staff over Luketich’s surgical practices failed to stop them, according to the law firm that represents D’Cunha.
The DOJ intervened in the lawsuit in 2021 over allegations that Luketich falsely billed federal healthcare programs for millions of dollars, in violation of medical necessity and teaching physician requirements.
The agency found that, along with falsely billing federal programs, Luketich’s surgical practices defied the medical standard of care and increased the risk of complications to patients, resulting in serious harm on at least several occasions.
According to the lawsuit, some of Luketich’s patients had to have additional surgeries or extended hospital stays as a result of Luketich’s conduct. Numerous patients developed painful pressure ulcers, while some were diagnosed with compartment syndrome, a dangerous condition caused by a buildup of pressure from internal bleeding or tissue swelling.
At least two patients had to undergo amputations, according to the DOJ.
UPMC “persistently ignored or minimized complaints” from employees regarding Luketich’s conduct and schedule, and “continued to allow Luketich to skirt the rules and endanger his patients,” according to the lawsuit. UPMC actually promoted Luketich and his practice during that period, advertising him and his department as a leader in minimally invasive surgical procedures. The physician is one of the Pittsburgh-based system’s highest paid employees, receiving more than $2.4 million annually from 2017 through 2019.
The Pittsburgh-based system and Luketich moved to dismiss the case in 2021, arguing that federal billing rules don’t prohibit concurrent surgeries, and that Luketich was present at critical moments in surgeries. The American Hospital Association filed an amicus brief in support of the system, contending the case threatens hospitals’ ability to develop internal policies for managing complex surgeries.
In June, however, a district judge allowed the case to continue, finding the prosecution’s claims were plausible.
UPMC did not respond to a request for comment by time of publication.
