Fred Schulte, Kaiser Health News
The Justice Department on Monday accused a defunct chain of Tennessee-based ache clinics of dishonest Medicare and different taxpayer-funded well being insurers out of no less than $25 million in unnecessary urine drug exams and genetic testing.
The civil lawsuit names Comprehensive Pain Specialists, often known as Anesthesia Services Associates PLLC; 4 of its doctor homeowners; and a former prime government. The medical doctors embody Tennessee Republican State Sen. Steven Dickerson and Peter Kroll, each anesthesiologists.
At its peak, CPS ran 60 ache clinics in a dozen states and handled some 48,000 sufferers per thirty days, based on the go well with. It shut down abruptly final summer season, leaving many power ache sufferers scrambling to discover a new supply of narcotic medicines.
The Justice Department fraud case facilities largely on the corporate’s profitable urine-testing lab in Brentwood, Tenn., which CPS financed with a $1.5 million mortgage. The go well with additionally alleges overbilling from acupuncture and different companies provided to sufferers.
CPS was the topic of a November 2017 investigation by Kaiser Health News that scrutinized Medicare billings for urine drug exams.
Medicare and different federal packages paid over $70 million from 2011 to 2018 for CPS-ordered urine exams, an quantity the lawsuit referred to as “staggering.” TennCare, the state’s Medicaid program, paid greater than $9 million extra throughout that point.
“For this reason, CPS considered [urine tests] to be ‘liquid gold’ — with revenues of tens of millions of dollars for what was largely unnecessary medical testing,” based on the go well with.
The chain’s homeowners and then-CEO John Davis “viewed every CPS patient as an opportunity to make money, without regard to the individualized need for treatment,” the go well with alleges. Davis was convicted final yr in Nashville on federal felony well being care fraud prices. He has since filed a movement for a brand new trial.
Dan Martin, an lawyer representing Kroll, mentioned in an emailed assertion: “We are aware of the allegations and very familiar with the actual facts. Dr. Kroll did not engage in any wrongdoing whatsoever, and we look forward to correcting the government’s misunderstanding of the facts.”
Dickerson’s lawyer, Ed Yarbrough, additionally issued an announcement that learn: “Dr. Dickerson is an honest man. We will prove that in court.”
In its investigation, KHN, with help from researchers on the Mayo Clinic, discovered that spending on urine screens and associated genetic exams quadrupled from 2011 to 2014 to an estimated $eight.5 billion a yr — greater than your complete price range of the Environmental Protection Agency. The federal authorities paid medical suppliers extra to conduct urine drug exams in 2014 than it spent on the 4 most advisable most cancers screenings mixed.
CPS was among the many nation’s most aggressive testers. KHN discovered that in 2014 5 of its medical professionals stood among the many nation’s prime billers. Anita Bayles, a nurse practitioner working at a CPS clinic in Cleveland, Tenn., generated $1.1 million in urine-test billings that yr, based on Medicare information analyzed by KHN.
The Justice Department go well with says that CPS believed Bayles ordered too many urine exams and overprescribed opioids and in September 2016 determined to fireplace her. But the choice was reversed by CEO Davis “because of her ability to generate revenues,” based on the go well with. Bayles couldn’t be reached for remark.
Though CPS ran six or extra urine exams a yr on many sufferers receiving narcotics, its medical doctors typically didn’t evaluate the outcomes to ensure sufferers didn’t abuse them, based on the go well with.
Kroll, who additionally served as CPS’ medical director, advised KHN in 2017 that the excessive quantity of exams was justified to maintain sufferers protected and to scale back possibilities of black market gross sales of capsules. Kroll billed Medicare $1.eight million for urine exams in 2015, the KHN evaluation of Medicare billing information discovered.
Kroll mentioned in a 2017 interview that he and Dickerson got here up with the thought to open a high-quality ache follow over a cup of espresso at a Nashville Starbucks in 2005.
But the Justice Department alleges that CPS expanded quickly by bilking the federal government, conduct that its prime executives and founders “failed to take any action to stop,” based on the go well with.
In what is named a “particularly egregious example of this fraudulent conduct,” the Justice Department alleged that Kroll prompted over 2,500 claims to be submitted to Medicare, for which CPS was paid virtually $350,000, throughout a 10-day interval in May 2017 when Kroll was on trip in Italy.
“Because of these fraudulent claims, Kroll’s billing privileges with Medicare have been revoked,” based on the go well with.
The lawsuit states that Medicare officers started investigating overcharging for urine testing at CPS in 2014 and finally directed the corporate to repay the federal government $27.four million in an extrapolated penalty. But CPS aggressively appealed the choice and managed to get it overturned and keep in enterprise.
Once among the many largest ache administration teams within the Southeast, CPS crumbled amid monetary woes that included almost a dozen civil fits alleging unpaid money owed, in addition to the felony case in opposition to Davis. In a courtroom submitting in December, the corporate mentioned that it had terminated all of its workers and that its money owed “greatly exceed its assets.”
In whole, Medicare paid CPS over $150 million from 2011 to 2018, a big a part of which was associated to urine testing, whereas TennCare paid CPS over $32.5 million, based on the go well with.
The Justice Department grievance consolidates a number of whistleblower circumstances filed in opposition to the corporate by medical doctors and different former workers. Federal whistleblower circumstances search restoration of cash paid improperly and may embody treble damages, or thrice the quantity of the unique overpayment.
One of the whistleblowers mentioned he toured the lab with CPS executives and noticed an “overpowering and unpleasant smell of urine.” In response, a CPS government mentioned, “To me, it smells like money,” based on the whistleblower’s go well with.
Kaiser Health News (KHN) is a nationwide well being coverage information service. It is an editorially impartial program of the Henry J. Kaiser Family Foundation which isn’t affiliated with Kaiser Permanente.