Pittsburgh-based UPMC agreed to pay $38 million to settle a whistleblower lawsuit alleging neurosurgeons employed by the health system submitted false claims, Pittsburgh Post-Gazette reported May 10.
Here are six things to know about the settlement
1. The suit was filed against the health system and 13 staff neurosurgeons in 2012 by former UPMC neurosurgeon William Bookwalter, MD, neurophysiologist Robert Sclabassi, MD, PhD, and surgical technologist Anna Mitina.
2. The suit alleged some neurosurgeons submitted claims for purportedly assisting with procedures performed by other surgeons or residents even though they did not assist nor supervise. Additionally, one neurosurgeon allegedly submitted fraudulent claims to Medicare for levels of spinal decompression not performed.
3. The allegations also resolved claims neurosurgeons were paid excessive compensation and surgeons referred procedures and surgeries to UPMC in violation of Stark law.
4. UPMC agreed to pay $2.5 million to settle some of the allegations in 2016, but whistleblowers continued to pursue claims not covered by the 2016 settlement.
5. According to a report from law firm Morgan Verkamp, the settlement is one of the largest Stark law recoveries in a case where the United States declined to intervene. Whistleblowers will be paid more than $11 million, or 29% of the amount recovered.
6. "UPMC is pleased to have resolved this matter, twelve years after it first started," Paul Wood, vice president and chief communications officer at UPMC, said in a statement shared with Becker's. "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."