Becker's ASC Review

38 ORTHOPEDICS UPMC alleged Stark Law violations over neurosurgeon pay revived: 6 things to know By Laura Dyrda U PMC may face whistleblower claims that it violated Stark Law and the False Claims Act in its dealings with neurosurgeons once again, aer the claims was initially dismissed. Six things to know: 1. Whistleblowers filed a suit in 2012 alleg- ing UPMC, Pittsburgh Physicians — which UPMC owns — and neurosurgeons submit- ted 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. e government did not intervene in the hospital service claims. 2. Aer 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 Medi- care and Medicaid. 3. e whistleblowers alleged that the health system's contract with surgeons incentivized surgeons to maximize their work relative value units so the surgeons reported per- forming higher volumes and more com- plex 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. ey also alleged surgeons performed "medically unnecessary" or "needlessly complex" pro- cedures to boost the wRVUs with UMPC's knowledge. 5. e District Court previously dismissed the suit, but the ird Circuit reversed that decision on appeal. ird Circuit found that there were enough facts to move forward with the whistleblowers' allegations, stating: "e relators' complaint alleges enough facts to make out their claim. e 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. e ird 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." n Neurosurgeon faces murder charges in California over opioid over- prescription: 4 details By Laura Dyrda T homas Keller, MD, a California-based neurosurgeon, plead- ed not guitly to second degree murder charges stemming from when he allegedly wrote non-medically necessary opioid prescriptions from 2011 to 2017. Four things to know: 1. The California Attorney General's office reported Dr. Keller was arrested and arraigned in connection with five patient deaths after he prescribed them "dangerously high levels of addictive opi- oids and narcotics." He allegedly prescribed Vicodin, oxycodone, OxyContin, Percocet and morphine outside acceptable levels for clinical practice. 2. Dr. Keller faces second-degree murder charges related to nine patients and felony elder abuse charges connected with five patient deaths. He is in custody, and with his bail set at $12 million. 3. A complaint filed in the Superior Court for Santa Rosa County alleges Dr. Keller prescribed maximum dosages of 180 to 300 pills per prescription, which exceeds the 50 mg Morphine Equivalent Dosage standard set by the CDC. He received red flag warnings from pharmacies and insurance companies, but continued to pre- scribe the high level of dosages. 4. The California Department of Justice's Bureau of Medi-Cal Fraud and Elder Abuse conducted an investigation that sparked this case. n Sanford settles alleged neurosurgeon anti- kickback violation suit for $20M By Laura Dyrda S ioux City, S.D.-based Sanford Health is set- tling a lawsuit with the federal government that accused former Sanford neurosurgeon Wilson Asfora, MD, of anti-kickback violations, according to the Argus Leader. Four things to know: 1. Sanford agreed to settle the whistle-blower lawsuit for more than $20 million, reported the Argus Leader on Oct. 28. 2. The lawsuit accused Dr. Asfora of performing unnecessary surgeries using medical devices that he had ownership interest in. 3. A whistleblower originally filed the lawsuit in 2016, and a federal investigation followed. 4. Sanford employed Dr. Asfora until last month, when the system terminated his contract. n

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