Description: Pittsburgh, Pennsylvania civil defense lawyer represented the Defendant accused of fraud.

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.

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.

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.

“This is an important settlement and a just conclusion to the United States’ investigation into Dr. Luketich’s surgical and billing practices, and UPMC and UPP’s acceptance of those practices,” said Acting U.S. Attorney Rivetti. “This Office is committed to safeguarding the Medicare and Medicaid programs, and to protecting those programs’ beneficiaries. No medical provider – however renowned – is excepted from scrutiny or above the law.”

“The Complaint alleged that Dr. Luketich used his position as a trusted doctor to defraud the health care system,” said FBI Pittsburgh Special Agent in Charge Mike Nordwall. “Health are fraud costs our country billions of dollars each year. This money is not just absorbed. It is passed down to the consumer. The Settlement Agreement provides that UPMC will implement a Corrective Action Plan for Dr. Luketich, and he will now have to undergo close scrutiny of his work.”

“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,” said Special Agent in Charge Maureen R. Dixon 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 False Claims Act is one of the most powerful tools in the United States’ continued efforts to combat health care fraud. The Act’s whistleblower (or “qui tam”) provisions authorize private parties to sue on behalf of the United States for false claims and share in any recovery, and permit the United States to intervene and take over the lawsuit, either in its entirety, or in part (as it did here). Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services, at 800 HHS TIPS (800-447-8477).

Assistant United States Attorneys Lee Karl and Adam Fischer litigated this case on behalf of the United States. Prior to the filing of the Government’s Complaint, this matter was investigated by U.S. Attorney’s Office for the Western District of Pennsylvania, the U.S. Department of Health and Human Services Office of Inspector General, and the Federal Bureau of Investigation, in conjunction with the Internal Revenue Service – Criminal Investigation, the Department of Defense Office of Inspector General, the Drug Enforcement Administration, Department of Veterans Affairs Office of Inspector General, and the Pennsylvania’s Office of the Attorney General.

Outcome: Settled for $8.5 million.

Plaintiff's Experts:

Defendant's Experts:

Comments: