DOJ announces $8.5M settlement against physician that billed for ‘concurrent surgeries’

A thoracic surgeon, hospital, and physician group will pay $8.5 million to settle claims the physician billed Medicare for “concurrent surgeries,” according to the U.S. Department of Justice (DOJ).

Surgeon James L. Luketich, MD, the University of Pittsburgh Medical Center (UPMC), and University of Pittsburgh Physicians (UPP) were defendants in a DOJ lawsuit alleging Luketich “regularly performed as many as three complex surgical procedures at the same time.” The doctor “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 DOJ.

Those actions violated laws and regulations that prohibit teaching physicians from billing the United States for concurrent procedures. The practices were well known to UPMC leaders and increased the risk of surgical complications to patients, according to the DOJ announcement. The federal department investigated with the FBI, the U.S. Attorney’s Office for the Western District of Pennsylvania, the U.S. Department of Health and Human Services – Office of the Inspector General (HHS-OIG), and other agencies.

“Ensuring physicians and other health care entities provide honest and accurate information to their patients and government health care programs, is of the upmost importance,” Maureen R. Dixon, special agent in charge of the HHS-OIG Philadelphia Regional Office. “HHS-OIG will continue to work closely with our law enforcement partners to thoroughly investigate health care fraud allegations to protect the safety of patients and the integrity of taxpayer-supported health care programs.”

The federal lawsuit was filed under the False Claims Act and was based on a two-year investigation into allegations originally claimed by Jonathan D’Cunha, MD, a former surgeon at UPMC, according to DOJ.

A report by Pittsburgh television station WXPI-TV described Luketich as UPMC’s “star surgeon,” and cited the lawsuit in a report about a July 2022 court ruling in the case.

The patients suffered complications due to Luketich’s practices, including “painful pressure ulcers; deep tissue injuries; and in at least two cases amputations,” the WXPI-TV report said, citing the DOJ complaint. There at least 15 examples of such practices between 2015 and 2019, according to the television report.

In September 2021, UPMC pledged to fight the claims. UPMC described Luketich as “a uniquely skilled and world-renowned cardiothoracic surgeon,” who would take on “hopeless” patients with chronic illness or cancer.

The medical center argued the DOJ claims were based on misapplication or misinterpretation of UPMC policies and guidance by the U.S. Centers for Medicare and Medicaid Services (CMS), according to a separate report by WXPI-TV.

As part of the settlement, UPMC and UPP will have a corrective action plan for Luketich and must have a year-long, third-party audit of his physician fee services billings to Medicare. UPMC may request guidance and advisory opinions regarding CMS regulations about surgeries at issue in the case, according to DOJ.

Luketich remains involved in a medical malpractice case filed in Allegheny County Common Pleas Court involving a patient who sued over an alleged botched lung transplant, according to a report by the Pittsburgh Post-Gazette.