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Justice News

Department of Justice
U.S. Attorney’s Office
Western District of Pennsylvania

Wednesday, July 27, 2016

False Claims Act Violation by UPMC Resolved for $2.5 Million

PITTSBURGH – The University of Pittsburgh Medical Center, together with the University of Pittsburgh Physicians, UPMC Community Medicine, Inc., and Tri-State Neurosurgical Associates-UPMC, Inc. (“UPMC”) have agreed to pay the United States $2,520,429 to settle False Claims Act allegations, United States Attorney David J. Hickton announced today.

The settlement resolves several of the allegations in a whistleblower lawsuit filed in federal court in Pittsburgh, Pennsylvania. The settled claims contended that UPMC violated the False Claims Act by submitting false claims for payment to the Medicare program. Specifically, the Complaint alleged that certain neurosurgeons employed by UPMC submitted claims for assisting with or supervising surgical procedures performed by other surgeons, residents, fellows, or physician assistants, when those neurosurgeons did not participate in the relevant surgeries to the degree required. The settlement also resolves allegations that a particular neurosurgeon, when performing multi-level spinal surgeries, submitted claims to the Medicare program for levels of spinal decompression not actually performed. Several claims asserted by the whistleblowers in their Complaint are not resolved by this settlement. The whistleblowers will continue to independently pursue those claims.

“Today’s settlement demonstrates our commitment to protecting federal health care programs from fraud,” said U.S. Attorney Hickton. “By pursuing false claims act cases like this, we send a clear message that health care providers must follow the rules when they deal with federal health care programs, and that this Office will hold accountable those who do not.”

This matter was investigated by the Office of Inspector General of the Department of Health and Human Services and the Federal Bureau of Investigation. Assistant United States Attorneys Colin J. Callahan and David Lew handled this matter on behalf of the United States.

This case is captioned United States ex rel. J. William Bookwalter, III, M.D., et al. v. UPMC, et al., Civ. No. 12-145 (WDPA). The claims resolved by the settlement are allegations only, and there has been no determination of liability.

Updated July 27, 2016