Jenna Spinelle Aug. 4, 2016, 9:56am


PITTSBURGH — One of Pennsylvania’s largest health care providers has come under scrutiny for the alleged billing practices of some in its neurosurgery department.

UPMC, along with University of Pittsburgh Physicians Inc., UPMC Community Medicine Inc. and Tri-State Neurosurgical Associates-UPMC, have agreed to pay $2.5 million as a result of a whistleblower lawsuit filed in U.S. District Court in 2012 claiming that neurosurgeons completed overly complex surgeries in order to increase insurance billings.

The suit - filed by neurosurgeon William Bookwalter, retired neurologist Robert Sclabassi and UPMC Presbyterian surgical technician Anna Mitina - claimed the billing resulted in what the lawsuit calls “astonishing” growth starting in 2006 and UPMC Presbyterian being the nation’s top-grossing acute care hospital in 2009.

More complex surgeries can be billed at a higher rate, and the suit alleged that surgeons were under pressure from the department to increase billings and hours worked.

In a written statement provided to the Pennsylvania Record, UPMC said that the surgeons themselves were not responsible for the billing errors.

“UPMC learned that some of the billing these entities submitted did not accurately reflect the services performed, and resulted in more reimbursement than was due. The physicians themselves did not submit these bills,” the statement said.

David J. Hickton, U.S. attorney for the Western District of Pennsylvania, said in a statement that the settlement was intended to send a message about the importance of ethics and accuracy in the medical field.

“Today’s settlement demonstrates our commitment to protecting federal health care programs from fraud,” the statement read. “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.”

UMPC said it admits no liability as part of the settlement and complied with all required investigations, even conducting its own internal review of the billing practices in question.

“UPMC discovered the billing discrepancies, disclosed the errors to the United States Attorney’s Office, conducted an internal review, and fully cooperated with the government’s review,” it said.

UPMPC spokesperson Gloria Kreps said the organization declined to comment beyond what appeared in the written statement.

The settlement covered three claims raised in the suit but several others remain against UPMC and its partners, leaving open the possibility for individuals to pursue further legal action.

Organizations in this Story

University of Pittsburgh Medical Center
200 Lothrop St
Pittsburgh, PA 15213

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