Experts: UPMC's reputation is safe despite federal false billing allegations

UPMC likely will not be significantly impacted by news this week that the U.S. Attorney’s office is suing the health system and its head of cardiothoracic surgery, according to experts in health care marketing.

On Thursday, the federal government filed a civil action against Dr. James Luketich and UPMC, alleging that his practice of scheduling multiple concurrent surgeries simultaneously violated Medicare billing laws and patient standards of care.

An attorney for Luketich vehemently denied the allegations, as did UPMC, which had previously featured the long-time surgeon in ads promoting medical advancements.

Although the civil complaint referenced one of those advertisements that had been posted to YouTube, by Friday morning, that link said the video was unavailable and is private.

A spokesman for UPMC did not respond to questions about the removal of the video.

Roberta Clarke, who teaches health care marketing at Brandeis University and taught the first such course in the country at Boston University, said Massachusetts General Hospital faced similar allegations several years ago.

There, an orthopedic surgeon filed a lawsuit against others alleging concurrent surgeries that defrauded Medicare.

The whistleblower, Dennis Burke, was fired, but ultimately settled his lawsuit with the hospital system for $13 million.

Despite the amount of publicity the allegations and the lawsuit at Mass General had, Clarke said, there was almost no impact on the hospital “because Mass General is Mass General,” Clarke said.

“And I think UPMC is the same.”

According to UPMC’s website, the $23 billion health care provider and insurer includes 92,000 employees, 40 hospitals, 800 doctor’s offices and an insurance division with 4 million members.

It is the largest nongovernmental employer in the state and has a reputation for providing quality medical care.

Allegations of concurrent surgeries, Clarke said, almost always only happen at teaching hospitals. UPMC and Mass General are reputed as teaching hospitals.

“It’s not going to make you say, ‘Oh, I won’t go to UPMC,’” Clarke said. “It will make you ask ‘Are you going to be in the OR the whole time?’”

George Sillup, chair of pharmaceutical and health care marketing at Saint Joseph’s University, said some patients might choose a different provider over an issue like this. But it will not upend the hospital system.

“They’re too prestigious and renowned,” Sillup said.

Sillup was surprised to hear that UPMC defended Luketich in its statement on Thursday. Instead, he expected the administration would try to distance itself from the surgeon.

“What he’s doing is endangering patients,” Sillup said. “It makes you wonder about the other procedures — will a similar thing happen in orthopedic surgery?”

Although the civil complaint against UPMC and Luketich spelled out adverse consequences for several patients, a Harvard Medical School and Stanford University study published in the Journal of the American Medical Association in February 2019 found that concurrent, or overlapping, surgeries are considered to be safe — but with two exceptions.

Patients deemed high risk, as well as patients undergoing coronary artery bypass experienced higher mortality rates and complication rates in concurrent procedures, the study found.

The complication rate was 29.2% for patients in overlapping procedures and 27% for those in non-concurrent surgeries. The mortality rate for patients in non-overlapping procedures was 1.6%, the study found, compared with 1.9% for those in concurrent surgeries.

“These are small numbers, but if you’re in those small numbers, it’s 100%,” Clarke said.

But most patients, when deciding on what doctor or hospital system to choose, won’t look at mortality and morbidity outcomes.

“They think ‘I have a good physician, and that’s all that matters,’” she said.

More than that, a patient who sees their surgeon in high demand will think that shows how good they are, Clarke added.

Patients, she said, don’t care about Medicare fraud, and they don’t care about the money that is lost.

“They don’t realize there is a danger to spending more time in the operating room,” Clarke said.

Most patients, too, she said, don’t know their doctors are performing concurrent procedures.

“This is not transparent,” Clarke said.