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Leslie C. Davis UPMC- Accused of violating the False Claim Act. (2024)

Leslie C. Davis UPMC
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Leslie C. Davis UPMC- UPMC's president and CEO is Leslie C. Davis.
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Leslie C. Davis UPMC- UPMC’s president and CEO is Leslie C. Davis. Leslie C. Davis UPMC claims to be very experienced in her profession as she mentions that she has over 30 years of expertise in health care, with a focus on operations and the development of businesses and services. Leslie C. Davis UPMC claims that she was most recently executive vice president of UPMC and president of the Health Services Division, which claims to include  40 hospitals and 4,900 employed physicians, 23 senior community facilities, a wide range of clinical specialty service lines, and pre-and post-acute services such as senior living, rehabilitation, and home care.

As asserted by Leslie C. Davis UPMC she was president of UPMC Magee-Womens Hospital from 2004 to 2018, and she also served as senior vice president and chief operating officer of the Health Services Division for seven years beginning in 2014.

Showcasing her leadership and achievements Leslie C. Davis UPMC claims that she held a variety of major leadership positions at health institutions in New York City and Philadelphia prior to joining UPMC. Leslie C. Davis UPMC mentions that she served as president of Graduate Hospital in Philadelphia, which is part of Tenet Healthcare Corp., as chief operating officer for Presbyterian Medical Center and the Hospital of the University of Pennsylvania, as chief marketing and planning officer at Penn Medicine, and as vice president of clinical affiliations and ambulatory programs at Thomas Jefferson University in Philadelphia for 13 years. Leslie C. Davis UPMC began her work at New York City’s Mount Sinai Medical Center

Leslie C. Davis UPMC, claims to be a native of Long Island, New York, and attended the University of South Florida and Harvard University, where she obtained a Master of Education in administration, planning, and social policy.

Leslie C. Davis UPMC- UPMC

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The University of Pittsburgh Medical Center (UPMC) is a 92,000-person American integrated global nonprofit health enterprise with 40 hospitals and over 8,000 licensed beds, 800 clinical locations including outpatient sites and doctors’ offices, a 3.8 million-member health insurance division, and commercial and international ventures. It has strong ties to its academic partner, the University of Pittsburgh.

It is regarded as a premier American healthcare provider, with its flagship facilities ranking in the “Honor Roll” of the approximately 15 to 20 greatest hospitals in America for over 15 years. U.S. News & World Report placed its flagship hospital, UPMC Presbyterian, 12th nationwide among the finest hospitals (and first in Pennsylvania) in 15 of 16 specialty areas including UPMC Magee-Womens Hospital. This does not include UPMC Children’s Hospital of Pittsburgh which ranked in the top 10 of pediatric centers in a separate US News ranking.

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Leslie C. Davis UPMC- The United States Files a False Claims Act Suit Against UPMC, Its Physician Practice Group, and the Chair of Its Department of Cardiothoracic Surgery

Acting U.S. Attorney Stephen R. Kaufman announced today that the United States has filed a False Claims Act complaint against the University of Pittsburgh Medical Center (UPMC), University of Pittsburgh Physicians, and James Luketich, M.D. in the United States District Court for the Western District of Pennsylvania. The complaint alleges that the defendants knowingly submitted hundreds of materially false claims for payment to Medicare, Medicaid, and other government health benefit programs over the past six years, based on a two-year investigation into allegations originally brought by a former UPMC physician under the False Claims Act’s whistleblower provisions.

The complaint specifically alleges that Dr. Luketich, the longtime chair of UPMC’s Department of Cardiothoracic Surgery, routinely performs up to three complex surgical procedures at the same time, fails to participate in all of the “key and critical” portions of his surgeries, and forces his patients to endure hours of medically unnecessary anesthesia time as he moves between operating rooms and attends to other patients or matters.

According to the complaint, the defendant’s conduct violates statutes and regulations, including those that ban “teaching physicians” (such as Dr. Luketich) from performing and billing the United States for “concurrent surgeries.” More importantly, the complaint contends that Dr. Luketich’s activities breach the standard of care and patients’ confidence, and heighten the risk of serious complications.

“The laws prohibiting ‘concurrent surgeries’ are in place for a reason: to protect patients and ensure they receive appropriate and focused medical care,” stated Acting U.S. Attorney Kaufman. “Our office will take decisive action against any medical providers who violate those laws, and risk harm to Medicare and Medicaid beneficiaries.”

When physicians and other healthcare providers prioritize financial gain over patient well-being and accurate billing of government healthcare programs, they violate the public’s basic trust in medical professionals,” said Special Agent in Charge Maureen R. Dixon of the HHS-OIG Philadelphia Regional Office. Our agency, in collaboration with our law enforcement partners, will continue to thoroughly investigate such healthcare fraud allegations in order to protect patient’s health and the integrity of taxpayer-funded programs serving them.

“Doctors take an oath to uphold the highest levels of ethical standards and care,” said FBI Pittsburgh Special Agent in Charge Mike Nordwall. “The allegations set forth today violate those ethics, painting a picture of fraud and deception. The FBI will continue to investigate fraud in our health care system and hold those accountable to face the consequences of their actions.”

The False Claims Act is one of the most powerful tools in the United States’ continued efforts to combat healthcare fraud. The Act’s whistleblower provisions authorize private parties to sue on behalf of the United States for false claims and share in any recovery and permit the United States to intervene and take over the lawsuit, either in its entirety or in part. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement can be reported to the Department of Health and Human Services.

The United States Attorney’s Office for the Western District of Pennsylvania, the United States Department of Health and Human Services Office of Inspector General, and the Federal Bureau of Investigation investigated this matter in collaboration with the Department of Defense Office of Inspector General, the Drug Enforcement Administration, the Internal Revenue Service – Criminal Investigation, the Department of Veterans Affairs Office of Inspector General, and the Pennsylvania Office of Inspector General.

Reference- Western District of Pennsylvania | United States Files Suit Against UPMC, Its Physician Practice Group, and the Chair of Its Department of Cardiothoracic Surgery for Violating the False Claims Act | United States Department of Justice

Leslie C. Davis UPMC- False Claim Act( The Act which was violated by Leslie C. Davis UPMC)

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The False Claims Act (FCA) is an American federal legislation that holds individuals and businesses (usually federal contractors) accountable for defrauding government programs. It is the primary litigation weapon used by the federal government to combat government fraud. The law contains a qui tam clause that allows those who are not linked with the government, referred to as “relators” under the law, to bring actions on the government’s behalf. This is referred to colloquially as “whistleblowing,” especially when the relator works for the organization being sued. Persons who file proceedings under the Act are entitled to a part of any recovered damages.

Whistleblowers started more than 71% of all FCA actions in 2019. Claims under the legislation have often concerned health care, military, or other government expenditure programs, and they account for the majority of the largest pharmaceutical settlements. The government recovered more than $62 billion under the False Claims Act between 1987 and 2019.

  • The False Claims Act is a federal law that provides a mechanism by which the federal government can recover monies for improper insurance claims filed or other actions that result in the government sustaining financial damages.
  • The act is a unique piece of American law because it allows third parties (often employees) to file claims against their employer on behalf of the government and to receive a portion of the recovered amounts as payment.
  • Claims filed under the act can be avoided if providers and health systems have built-in accurate and accountable billing practices. 

Leslie C. Davis UPMC- The offending Act (How Leslie C. Davis UPMC offended the Act)

The FCA expressly lists a few sorts of offenses, such as when a party:

1) Submits a bogus claim for payment or approval on purpose

2) Using a misleading statement or document to support a fraudulent claim on purpose 

3) Keeps a government overpayment or otherwise keeps a portion of revenue for services not performed. 

4) Modifies a document in order to change the amount owed to or by the government. 

Billing for services that were not really performed, duplicate billing, overcharging, using unlicensed individuals but paying for licensed providers, filing any type of false claim, and keeping Medicare or Medicaid overpayments are common instances of these types of acts.

Leslie C. Davis UPMC- Penalties (Which are subjected to Leslie C. Davis UPMC)

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Penalties for violating the FCA often follow a simple calculation: Offending parties are required to pay three times the amount of damages suffered by the government as well as $2,000 per improper claim filed. However, in cases where the court believes the offending party acted with malice, bad faith, or in a particularly heinous manner, the judge may increase the penalties to compensate. The amount qui tam claimants are entitled to can vary — typically from 15% to 30%. 

Leslie C. Davis UPMC- Wrap-UP- How to Stop Violating the False Claim Act which was violated by Leslie C. Davis UPMC

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The False Claims Act’s criteria are simple: only make claims for services that are really performed, and file them correctly. 

If you get payments from federal healthcare programs, make sure the amounts are correct and correspond to what you expect to receive, especially if there is an overpayment. If you have been overpaid, contact your healthcare program’s billing contact immediately and work together to establish the best method to remedy the overpayment. The amount may be deducted from your next month’s payment in some situations. However, in some cases, sending the money back straight soon may be necessary. Transparency and honesty are key: If you or a billing representative makes a mistake, reach out to remedy that as soon as possible. Mistakes happen, but where an office has a demonstrated pattern of inaccurate claims, problems can arise. 

Leslie C. Davis UPMC- Bottom Line

The False Claims Act allows the government and some third parties to hold companies accountable for dishonest and fraudulent business practices. FCA claims can be avoided if providers and health systems have built-in accurate and accountable billing practices. When a billing issue is discovered, it should be addressed quickly and transparently to avoid any issues.

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Leslie C. Davis UPMC- Accused of violating the False Claim Act. (2024)
Leslie C. Davis UPMC- Accused of violating the False Claim Act. (2024)

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