• Family of patient who died after orthopedic surgery wins $35M verdict against hospital
  • Orthopedic surgeon wins $20M verdict against Johnson & Johnson
  • Minnesota orthopedic group hit with $111M negligence verdict
  • Orthopedic patient's death highlights potential dangers of prior authorization
  • Spine surgeon's video hits 1 million views on TikTok
  • Spine surgeon killed in Oklahoma hospital shooting
  • Spine surgeon owes $17M to paralyzed patient
  • Providence to pay $22.7M to settle unnecessary spine surgery allegations
  • Spine surgeon gets jail time for abusing patient during hospital visit
  • 'They're on really thin ice': Why 1 insurer has drawn spine surgeons' ire
  • Connecticut hospital to appeal $12.5M verdict to family of patient who died after orthopedic surgery
  • Orthopedic surgeon must face suit in patient's death
  • Spine surgeon 1 of 9 physician billionaires on Forbes' 2022 list
  • 23 spine device companies to watch in 2022
  • 4 spine technologies that promised more than they delivered
  • Orthopedic surgeon salary vs. average household income in each state
  • Orthopedic surgeon's health system exit steeped in controversy
  • Terminated orthopedic surgeon contracts with another New York hospital
  • Orthopedic surgeon convicted of battery at hospital
  • Billionaire spine surgeon buys $23.9M mansion
  • UArizona neurosurgery chair dies after motorcycle collision
  • Texas spine surgeon sued by State Farm over 'unnecessary' procedures
  • The spine tech surgeons say will explode in the next 5 years
  • Could Medtronic's spine business be the next medtech spinoff?
  • Ex-NFL player gets 5 years in prison for $2.9M healthcare fraud scheme
  • 41 'rising stars' in orthopedics
  • Orthopedic surgeon indicted in $10M telemedicine fraud scheme
  • Neurosurgeon's startup hits $1.2B valuation
  • Orthopedic surgeon fined for operating on wrong knee
  • Lawsuits build against Aetna's spine surgery coverage
  • Good news, bad news for orthopedic surgeons: 6 observations
  • Former spine surgeon owes $13M to 2 women over unnecessary procedures
  • Walmart's latest partnership pushes retailer into spine care
  • Texas spine surgeon's $11M verdict being appealed
  • 10 power players in orthopedics
  • Rothman Orthopaedics to become national brand, but no 'aspirations to go beyond US'
  • Sports medicine physician fired amid misconduct allegations involving patients
  • Orthopedic surgeon allegedly exaggerated patient visits to defraud insurers
  • Top orthopedic hospital in every state: US News
  • Orthopedic surgeon asking for misconduct charges to be dropped
  • Neurosurgeon pay Stark Law violation allegations against UPMC revived: 6 things to know

    Neurosurgeon pay Stark Law violation allegations against UPMC revived: 6 things to know

    Laura Dyrda -  

    UPMC may face whistleblower claims that it violated Stark Law and the False Claims Act in its dealings with neurosurgeons once again, after the claims was initially dismissed.


    Six things to know:

    1. Whistleblowers filed a suit in 2012 alleging UPMC, Pittsburgh Physicians — which UPMC owns — and neurosurgeons submitted false claims to Medicare and Medicaid, and the government intervened in the claims against the physicians, which were settled four years later for $2.5 million. The government did not intervene in the hospital service claims.

    2. After the initial government intervention, the whistleblowers filed claims that UPMC and Pittsburgh Physicians submitted false claims and knowingly made false records that resulted in reimbursement from Medicare and Medicaid.

    3. The whistleblowers alleged that the health system's contract with surgeons incentivized surgeons to maximize their work relative value units so the surgeons reported performing higher volumes and more complex procedures. From 2006 to 2009, the UMPC neurosurgery department more than doubled wRVUs billed.

    4. Whistleblowers also alleged surgeons reported assisting in surgeries and served as teaching physicians when they did not. They also alleged surgeons performed "medically unnecessary" or "needlessly complex" procedures to boost the wRVUs with UMPC's knowledge.

    5. The District Court previously dismissed the suit, but the Third Circuit reversed that decision on appeal. Third Circuit found that there were enough facts to move forward with the whistleblowers' allegations, stating: "The relators' complaint alleges enough facts to make out their claim. The surgeons' contracts make it very likely that their pay varies with their referrals. And the relators also make a plausible case that the surgeons' pay is so high that it must take referrals into account."

    6. The Third Circuit also found that UPMC and Pittsburgh Physicians should bear the burden of pleading Stark Act exceptions, noting: "And if that burden lay with the relators, their pleadings meet that burden here."

    Copyright © 2022 Becker's Healthcare. All Rights Reserved. Privacy Policy. Cookie Policy. Linking and Reprinting Policy.

    Featured Learning Opportunities

    Featured Webinars

    Featured Podcast

    Featured Whitepapers