Can a doctor bill Medicare and Medicaid for multiple surgeries performed at the same time? First, I don’t want my surgeon operating on me and other patients at the same time. I prefer he/she concentrate on performing my surgery safely and correctly. But, my concerns aside, can surgeons get away with this practice? The answer is apparently, “they think they can.”
The U.S. government and a former University of Pittsburgh Medical Center (UPMC) physician have filed a whistleblower lawsuit against UPMC and one of its standout surgeons after they allegedly charged Medicare and Medicaid the full freight for procedures the surgeon only partially conducted. UPMC, along with James Luketich, MD, chair of the cardiothoracic surgery department at the University of Pittsburgh School of Medicine, have been charged with three counts of violating the False Claims Act.
The lawsuit alleged that Luketich often staggered three surgeries, booking two adjacent rooms for the same time and then starting another nearby, which is “typically booked under another attending physician’s name.” It also alleges that UPMC allowed Luketich “to falsely attest that he was with his patients throughout the entirety of their surgical procedures or during all ‘key and critical’ portions of those procedures, and to unlawfully bill the Government for those procedures, all in order to increase surgical volume and maximize revenue.
UPMC billed for each surgery as if Luketich was leading each one. The system paid him more than $2.4 million annually from 2017 to 2019. UPMC also touted Luketich in advertisements and other marketing materials to attract more patients.
My Take: This is the type of billing fraud the False Claims Act was designed to punish. When the medical profession fraudulently bills Medicare and Medicaid in order to satisfy greed, everyone who pays taxes in America suffers. If you are aware of such medical billing fraud…call us.