UPMC settles $38M whistleblower lawsuit for Medicare fraud
The University of Pittsburgh Medical Center (UPMC) has settled a lawsuit brought by whistleblowers who alleged surgeons at the health system were performing unnecessary procedures to bolster earnings.
The case will now be settled out of court for $38 million. UPMC does not admit wrongdoing.
According to coverage in the Pittsburgh Post-Gazette, the lawsuit started in 2012 with a complaint from three UPMC clinicians who sued the health system and 13 staff neurosurgeons, claiming they unfairly billed Medicare for medically unnecessary procedures and received bonus pay as a result.
The Department of Justice (DoJ) declined to intervene in the case. Related false claim allegations were previously settled in 2016 by UPMC for $2.5 million in fines paid to the government. After which time, the three plaintiffs continued to pursue a new lawsuit on three claims not addressed in that initial settlement.
The three plaintiffs are set to receive $11 million for moving this second case forward. The payout is a reward to whistleblowers for bringing fraud cases to the attention of the government. The remaining $27 million will be paid by UPMC as a punitive fine to the government directly.
According to the plaintiffs, the $38 million settlement marks one of the largest false claim recovery judgements on record to not involve the DoJ.
Read the full story from the Pittsburgh Post-Gazette at the link below.
Chad is an award-winning writer and editor with over 15 years of experience working in media. He has a decade-long professional background in healthcare, working as a writer and in public relations.