The University of Pittsburgh Medical Center and the head of its cardiothoracic surgery department have agreed to pay $8.5 million to settle claims that they fraudulently billed Medicare and Medicaid for complex surgeries.
Efrem Grail, Luketich's attorney, said he hoped the settlement would lead to clearer guidance on billing "so that universally respected surgeons like Dr. Luketich can return their focus to training young doctors to save lives without having to put up with baseless claims of fraud."in the lawsuit in 2021. The case was brought under the federal False Claims Act, which allows private parties to bring lawsuits on behalf of the government and collect a portion of any recovery.
The lawsuit alleged that, in addition to resulting in hundreds of fraudulent bills to government health insurance programs, Luketich endangered patients by keeping them under anesthesia so he could attend to other patients. In some cases, patients allegedly developed complications as a result requiring further treatment.
UPMC and Luketich in November 2021 moved to dismiss the case, arguing that federal billing rules do not forbid concurrent procedures. They said that Luketich was acting as the leader of highly qualified surgical teams and was always present for the portions of the surgeries that he deemed critical.supporting the defendants, saying that the case threatened hospitals' ability to develop their own policies for managing complex surgeries to best serve patients.
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