On July 28th, reporters Kris B. Mamula and Torsten Ove reported the settlement of a law suit filed by a former UPMC neurosurgeon (and others), evolving from alleged fraudulent misconduct in billing and charging patients for unnecessarily complicated and costly operative procedures. UPMC, Affiliates agree to pay $2.5 Million in False Claims Settlement
According to the complaint, UPMC became the top-grossing neurosurgical group in the United States in 2009. It was alleged that this financial success was related to prior false acts at UPMC Presbyterian. It was claimed that UPMC’s income had been greatly increased because of improper conduct on the part of the neurosurgical staff at UPMC. These false acts generated tens of millions of dollars for UPMC and resulted from performing far more complicated procedures than were necessary and fraudulent billing practices. The lawsuit also alleges that the chairman of the neurosurgical department encouraged, if not “exhorted”, physicians to increase their workloads in order to increase income which would be distributed to individual physicians. These actions, according to the law suit, were the reasons why revenue grew in an “astonishing” fashion. The lawsuit alleges that UPMC “knowingly submitted tens, and possibly hundreds, of millions of dollars in fraudulent billings to Medicare and Medicaid for reimbursement based solely on lack of medical necessity.” Also, the lawsuit claims that doctors represented to Medicare and Medicaid that they were assisting other physicians in procedures when in fact they were spending little time in the operating rooms of various hospitals. These actions were said to have created “first assistant phantoms”. Equally troublesome are the allegations that physician assistants were performing procedures without attending physician’s supervision and some procedures were billed for that were never performed. A settlement between the U.S. Justice Department and UPMC, University of Pittsburgh physicians Inc., UPMC Community Medicine Inc., and Tri-State Neurosurgical Associates-UPMC was reached for $2.5 million dollars. According to the Post-Gazette article, the whistleblowers who filed the lawsuit are pursuing other remedies against UPMC and its affiliates.
As a law firm dedicated to protecting the interests of victims of medical malpractice, it is very disturbing to learn of these allegations of false and substandard conduct. This law firm recognizes the risks involved in neurosurgery, and these risks would be greatly increased by the claims set forth in the whistleblower complaint. Serious medical errors and fraudulent activity that result in serious injuries and potentially death should never occur. This law firm encourages any victims of this conduct to seek legal redress.