Monetary Incentives, a double-edged sword?

By Roshni Master, Staff Writer

Photo Curtesy of

A high salary or a large end-of-year bonus is typically considered a sign of success. However, University of Pittsburgh Medical Center’s (“UPMC”) Head of Cardiothoracic Surgery and star surgeon, Dr. James Luketich, may disagree.[1] The United States government has brought suit against Dr. Luketich, alleging Dr. Luketich repeatedly put patients at an increased risk by “conducting as many as three complex surgeries at the same time without being present for all key and critical portions, causing patients to endure hours of unnecessary anesthesia time”.[2] Furthermore, the complaint alleges Dr. Luketich falsely billed Medicare, Medicaid and other government programs for these procedures.[3]

Also concerning are the allegation that despite employees reporting Dr. Luketich’s conduct to UPMC management, the complaints were ignored or minimized.[4] The lawsuit is ongoing and is currently still in discovery.[5] Dr. Luketich is not the only physician who has been charged with misusing and abusing their power. Dr. Meir Daller, a urologist in Fort Myers, submitted claims to Medicare and Tricare for tests that were not medically necessary.[6] Dr. Daller settled the lawsuit against him for over $3.8 million dollars.[7]

These incidents of immoral conduct amongst professionals who take a Hippocratic Oath raise the question of why these providers intentionally engage in misconduct. Medical malpractice cases are abundant in this country, so much so that there are law firms dedicated solely to medical malpractice. To have a claim for medical malpractice, a plaintiff has the burden of showing four elements: (1) a duty; (2) breach of that duty; (3) that breach was a factual cause of the damages or increased the risk of harm; and (4) the extent of the damages.

Medical malpractice does not require a requisite intent. An example of medical malpractice would be a physician working a long shift and unintentionally leaving a sponge in a patient’s stomach. Physician misconduct, on the other hand, is based on a gross negligence standard of willful, wanton, and reckless conduct. In the cases of Daller and Luketich, a gross negligence standard is applied since Dr. Daller defrauded the government with the requisite knowledge and intent and Dr. Luketich has allegedly done the same.

Delving deeper into the rationale behind why providers choose to engage in willful, wanton, and reckless conduct, there is one factor that has led the human moral compass astray: money. Physicians are one of the highest paid professionals in the United States and are compensated based on a plan of their choice.[8] According to the New England Journal of Medicine, most compensation plans today are based on either salary, net revenue, or gross revenue along with some type of bonus or incentive component.[9]In specialties where there is a high demand for physicians, the incentive component can be particularly lucrative.[10] Dr. Jennifer Shu, a New Hampshire physician, explained that when she accepted her first job out of residency, she was offered the opportunity to earn up to an additional $10,000 a year provided her billings exceeded a certain amount at year-end.[11] However, Dr. Shu stated “the bar was set so high, it wasn’t humanly possible to earn the incentive payment.”[12] The lawsuits against Dr. Daller and Dr. Luketich exemplify how physicians around the country are sacrificing patient care to earn more money.


[2] Id.

[3] Id.

[4] Id.

[5] Id.

[6] ordering-unnecessary-medical-tests

[7] Id.


[9] Id.

[10] Id.

[11] Id.

[12] Id.

Comments are closed.