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UPMC to pay $2.5M+ to settle neurosurgery-related False Claims Act violation allegations: 7 things to know Featured

Written by  Megan Wood | Thursday, 28 July 2016 00:00
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The University of Pittsburgh Medical Center will pay the federal government more than $2.5 million to settle a case alleging violation of the False Claims Act, according to Law360.

Here are seven things to know:

 

1. The deal came into fruition after whistleblowers accused some of UPMC's neurosurgeons of billing Medicare for surgeries in which they did not participate in full.

 

2. The DOJ reported the Pennsylvania federal court qui tam suit alleges "neurosurgeons billed for assisting in or supervising procedures by other surgeons, residents, fellows and physician assistants that they weren't participating in to the required degree," according to Law360.

 

3. The DOJ also noted the case alleged a UPMC neurosurgeon billing Medicare for spinal decompression levels that were not performed during surgery.

 

4. Three UPMC-affiliated institutions submitted the bills in question to Medicare, Medicaid and Tricare. The institutions involved were University of Pittsburgh Physicians, UPMC Community Medicine and Tri-State Neurosurgical Associates UPMC.

 

5. UPMC alerted the U.S. attorney's office of the billing issues and has cooperated with government review.

 

6. Under the settlement, UPMC did not claim any liability.

 

7. The government did not act on all claims, including allegations of hospital kickbacks to surgeons who performed complex procedures.

 

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