Issue link: https://beckershealthcare.uberflip.com/i/1198635
10 SPINE SURGEONS Lawsuit over Stark Law violation allegations against neurosurgeon pay at UPMC revived: 6 notes By Laura Dyrda U PMC may face whistleblower claims that it violated Stark Law and the False Claims Act in its dealings with neurosurgeons 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 submitted 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 UPMC and Pittsburgh Physicians submitted false claims and knowingly made false records that result- ed in being reimbursed from Medicare and Medicaid. 3. e whistleblowers alleged the health sys- tem's contract with surgeons incentivized surgeons to maximize their work relative value units so the surgeons reported per- forming higher volumes and more complex procedures. From 2006 to 2009, the UMPC neurosurgery department more than doubled wRVUs billed. 4. Whistleblowers also alleged surgeons report- ed assisting in surgeries and served as teaching physicians when they did not. ey also alleged surgeons performed "medically unnecessary" or "needlessly complex" procedures to boost the wRVUs with UMPC's knowledge. 5. e District Court previously dismissed the suit, but the ird Circuit reversed that deci- sion on appeal. e ird Circuit found there were enough facts to move forward with the whistleblowers' allegations, stating: "e rela- tors' complaint alleges enough facts to make out their claim. e surgeons' contracts make it very likely that their pay varies with their re- ferrals. 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, not- ing: "And if that burden lay with the relators, their pleadings meet that burden here." n Sanford Health sends termination notice to neurosurgeon accused of Medicare fraud By Laura Dyrda S anford (Calif.) Health terminated a neurosurgeon shortly after the government decided to inter- vene in a whistleblower lawsuit alleging that he committed fraud, according to the Argus Leader. The lawsuit claims Wilson Asfora, MD, performed unnecessary spine surgery with a device made by a company he owned, and billed Medicare for ser- vices that weren't delivered, along with Sanford Health. The suit was unsealed in June after the U.S. Attorney's Office for the District of South Dakota filed a motion to intervene. At the time, the health system and its chief medical officer denied the alle- gation had merit. Dr. Asfora's lawyer confirmed the termination, effec- tive Sept. 24, to the Argus Leader. He also said Dr. As- fora "believes the allegations made in the lawsuit are bogus." n Dr. Scott Lynch sues Penn State for $50,000, alleges interference with medical decisions for athletes By Laura Dyrda S cott Lynch, MD, an orthopedic surgeon and former direc- tor of athletic medicine for State College, Pa.-based Penn State, sued the school and multiple officials, alleging they interfered with medical decisions and then retaliated against him after he reported it, according to Onward State. Three things to know: 1. In the lawsuit, Dr. Lynch claims Penn State football head coach James Franklin interfered with the team physicians with regards to treatment and return-to-play decisions. 2. Dr. Lynch claims he was removed from his position as direc- tor of athletic medicine and a team orthopedic surgeon after reporting the interference. Interim Dean of Penn State College of Medicine Kevin Black, MD, allegedly stated Dr. Lynch was replaced because the school wanted to bring on an orthope- dic surgeon who lived in State College, Pa., whereas Dr. Lynch lived in Hershey, Pa. 3. In his lawsuit, Dr. Lynch seeks $50,000 in damages, accord- ing to the report. n