Pittsburgh-based UPMC has agreed to pay $38 million to settle a whistleblower lawsuit filed against the health system and 13 staff neurosurgeons in 2012, according to the Pittsburgh Post-Gazette.
The lawsuit, filed by former UPMC neurosurgeon William Bookwalter, MD, neurophysiologist Robert Sclabassi, MD, PhD, and surgical technologist Anna Mitina, claimed certain neurosurgeons submitted false claims to Medicare, according to the Justice Department. The neurosurgeons allegedly submitted claims for assisting with or supervising surgical procedures performed by other surgeons, residents, fellows or physician assistants, even though they did not participate in the relevant surgeries to the degree required.
A particular neurosurgeon also allegedly fraudulently submitted claims to Medicare for levels of spinal decompression not actually performed, according to the Justice Department.
In 2016, UPMC agreed to pay $2.5 million to settle some of the false claims allegations. However, the whistleblowers continued to pursue claims not covered by the 2016 settlement.
As part of the latest settlement, the three plaintiffs will receive $11 million of the $38 million to be paid by UPMC, plaintiff lawyers said, according to the Post-Gazette. The rest will be paid to the federal government. The settlement does not require the health system to admit wrongdoing.
UPMC had argued in response to the lawsuit that its physician compensation packages, which include a base work rate plus a productivity bonus, are legal and commonly used within healthcare.
Paul Wood, vice president and chief communications officer at UPMC, shared the following statement with Becker's: "UPMC is pleased to have resolved this matter, twelve years after it first started. The settlement, which includes no admission of liability, allows UPMC to keep its focus where it belongs — on providing world-class care to our patients."