A Tennessee-based chain of ache clinics that abruptly shut down final summer season faces 5 whistleblower lawsuits accusing it of defrauding Medicare and different well being insurers by billing for lots of of pointless urine drug checks and different doubtful well being companies, newly unsealed court docket information present.
The federal fits goal Tennessee-based Comprehensive Pain Specialists, also referred to as Anesthesia Services Associates, PLLC, and a number of other of its doctor house owners. At its peak, CPS ran 60 ache clinics in 12 states, in response to the fits, in addition to a profitable urine-testing lab in Brentwood, Tenn. CPS closed with no warning in July, leaving sufferers in a number of states distressed and scrambling to discover a new supply of narcotic ache medicines.
In federal court docket filings unsealed in Nashville this week, federal prosecutors stated they might take over the urine-testing allegations and sue a number of CPS house owners, together with co-founding anesthesiologists Peter Kroll and Steven Dickerson. Dickerson is a Republican state senator representing Nashville.
Kroll couldn’t be reached for remark Wednesday. Dickerson didn’t reply to an e mail or a cellphone message left at his legislative workplace.
It isn’t clear whether or not the whistleblowers, who embody former CPS medical doctors and different workers, would pursue a number of allegations in opposition to the corporate that the federal authorities declined to hitch in. CPS, in an unrelated court docket submitting in December, stated the corporate had terminated all of its workers and that money owed “greatly exceed its assets.”
Once among the many largest ache administration teams within the Southeast, CPS crumbled amid monetary woes that included practically a dozen civil fits alleging unpaid money owed, and a legal investigation that ensnared its former chief govt, John Davis. Davis, 41, was convicted this month in federal court docket in Nashville on well being care fraud expenses. He is to be sentenced later this 12 months.
CPS was the topic of a November 2017 investigation by Kaiser Health News that scrutinized its Medicare billings for urine drug checks. Medicare paid the corporate a minimum of $11 million for urine screenings and associated checks in 2014, when 5 of CPS’ medical professionals stood among the many nation’s prime such Medicare billers. One nurse practitioner working at a CPS clinic in Cleveland, Tenn., generated $1.1 million in urine-test billings that 12 months, in response to Medicare information analyzed by KHN.
Kroll, who additionally served as CPS’ medical director, stated on the time that the checks have been justified for affected person security and to scale back probabilities the tablets is likely to be offered on the black market. Kroll billed Medicare $1.eight million for urine checks in 2015, the KHN evaluation of Medicare billing information discovered.
Kroll in an interview with KHN on the time stated that he and fellow anesthesiologist Dickerson got here up with the thought for the ache clinics over a cup of espresso at a Nashville Starbucks in 2005.
One of the whistleblower fits alleging pointless urine checks was first filed underneath seal in 2016 by Suzanne Alt, a physician who labored within the firm’s ache clinics in Troy, Mo., and Keokuk, Iowa, from May 2014 to March 2015. She alleged CPS medical doctors have been “strongly encouraged to order full-panel urine drug screens on each patient, every time, despite the patient’s history, compliance and risk.”
She additionally stated that the corporate’s digital medical information “made it extremely difficult to order anything less than the full panel.” Alt stated she was instructed the Tennessee lab did about 600 of those screens every day. Another whistleblower stated he toured the lab with CPS executives and noticed an “overpowering and unpleasant smell of urine.” In response, a CPS govt stated, “To me, it smells like money,” in response to the swimsuit.
“They were making a killing,” stated Birmingham, Ala., lawyer Don McKenna, who represents Alt within the case.
Another of the whistleblowers, former CPS anesthesiologist Cynthia Niendorff, alleged that the corporate billed Medicare about $754 for every extra urine take a look at, despite the fact that earlier outcomes had come again adverse. She stated CPS grossed roughly $6 million monthly from the urine-testing lab and stated about 20% of this quantity was suspect, in response to the swimsuit.
Mary Butner, a former insurance coverage specialist for CPS in Gallatin, Tenn., alleged that CPS charged some sufferers $1,500 for a drug take a look at to measure blood ranges of remedy and $400 for a drug take a look at designed to detect unlawful medicine — expenses that the swimsuit known as “grossly inflated and disproportional to the actual costs.” She additionally alleged that CPS would fill prescriptions for sufferers whose drug checks detected the presence of unlawful medicine, or confirmed that they weren’t taking their remedy as directed.
Butner additionally accused medical director Kroll of approving prescriptions for again braces when it was “clearly medically unnecessary,” together with some individuals who had accidents to a knee or elbow.