Federal prosecutors say that a two-year investigation shows that false billing by UPMC and its head of cardiothoracic surgery covered up practices that harmed patients.
The civil complaint filed by the U.S. Attorney for Western Pennsylvania claims that Dr. James Luketich went "back-and-forth between operating rooms and even hospital facilities, while his surgical patients remain[ed] under general anesthesia.” Prosectors say this led to violations of federal regulations and statutes. Yet Luketich, University of Pittsburgh Physicians and UPMC knowingly submitted false claims to Medicaid and Medicare during the past six years, according to prosecutors.
A portion of the allegations centers on billing regulations for teaching hospitals, such as those within the UPMC system. These require physicians who are not residents to be physically present during all key and critical portions of those surgeries.
Yet, investigators say Luketich had a pattern of not being present or immediately available, and that on several occasions he "left the operating room mid-surgery, and then could not later be located on-site by UPMC personnel, and did not immediately respond to pages, calls, and/or text messages."
Prosecutors say there were other occasions when Luketich's absence delayed surgical progress, "because he was out of the operating room, and in meetings or attending to other administrative matters." In one alleged instance he "could not be found for more than an hour."
Prosecutors claim Luketich’s actions also harmed patients, as the surgical delays resulted in complications such as painful pressure ulcers and deep tissue injuries. The complaint notes that at least two patients later underwent amputations.
“When treating these patients, Dr. Luketich leads teams of highly skilled surgeons and other clinicians through complex procedures that frequently last more than 12 hours. As the government also concedes, Dr. Luketich always performs the most critical portions of every operation he undertakes,” said UPMC in an emailed statement, noting that no law or regulation prohibits overlapping surgeries or billing for those surgeries.
Federal prosecutors say the investigation began after a former UPMC physician reported Luketich for filing false claims. Luketich's attorney, Efrem Grail, who specializes in representing white-collar defendants, said there is no accuracy to the government’s allegations.
“We expect that each of the patients that he treated are grateful and own their health, and in some cases their life for the care UPMC and Jim Luketich provided,” said Grail.
