PITTSBURGH ― The University of Pittsburgh Medical Center has paid $2.5 million to settle some claims in a federal whistleblower lawsuit accusing the hospital network of overbilling government insurance programs for neurosurgery.
UPMC, Pennsylvania’s largest private employer with 60,000 workers, didn’t acknowledge wrongdoing in the settlement announced Wednesday by the U.S. Attorney’s Office in Pittsburgh. The nonprofit reported $12 billion in revenue last year.
The federal government sued last year after two doctors and another whistleblower sued in 2012 alleging various kinds of inflated billing. Some of the whistleblower claims remain and will be pursued privately, and UPMC said it would defend those claims “vigorously.”
The claims settled primarily involve the way UPMC billed for surgeries in which some of its doctors acted as first assistants or teaching assistants on surgical procedures. Under regulations governing Medicare, Medicaid, Tricare/Champus and other federal programs, those assisting physicians must spend a certain amount of time or perform specific roles during surgery, otherwise UPMC cannot bill for their services.
The lawsuit claimed UPMC billed for the assistant services when those doctors didn’t meet the criteria and sometimes even when they weren’t present at all.
UPMC “created a culture where money ― not medicine ― drove the decision-making process,” the lawsuit said.
The lawsuit didn’t say how much money the overbilling allegedly cost the government programs or how the feds arrived at the $2.5 million settlement figure. UPMC didn’t address that issue in its statement.
