False Claims Allegations

03/01/23

James Luketich, MD and associated entities have agreed to pay $8.5M and initiate a Corrective Action Plan to settle False Claims allegations that Dr. Luketich “regularly performed as many as three, complex surgical procedures at the same time, failed to participate in all of the “key and critical” portions of his surgeries, and forced his patients to endure hours of medically unnecessary anesthesia time, as he moved between operating rooms and attended to other patients or matters.”  See the DOJ’s Press Release here.

The parties involved have made it onto OIG’s “High Risk – Heightened Scrutiny” website, which is for entities who refuse to enter into a Corporate Integrity Agreement (CIA), but whom the OIG has determined require additional oversight.

Reviewing and auditing Operational Processes, as well as Coding & Billing Rules and Practices, could prevent issues with the False Claim Act.

Areas that must be periodically evaluated include:

  • Ensuring operational workflows and timelines are realistic
  • Meeting coding requirements for the amount of time billed
  • Patient safety & quality

This takes a collaborative effort from all functional areas involved and can be enhanced by utilizing a neutral third-party to facilitate organizational goals.

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