NASHVILLE, Tenn. (WKRN) — Two Middle Tennessee pain clinics and their owners are accused of falsely billing for unneeded tests for patients in violation of the False Claims Act.
According to a release from the U.S. Department of Justice (DOJ) Michael and Debbie Cox, owners of Clarksville Pain Institute and Pain Institute of Nashville, violated the False Claims Act by knowingly submitting false claims for diagnostic testing services provided to patients that were not medically necessary, including urine drug screenings, allergy tests, and psychological tests dating back to 2014.
The complaint alleges the Coxes pressured staff at their Clarksville pain management clinic to bill for more testing than was medically necessary, that the practice routinely tested patients' urine then never reviewed results, and that the practice operated multiple schemes to maximize testing profits from different kinds of diagnostic testing.
Additionally, the complaint states the defendants ignored multiple warnings from consultants, auditors, and insurers that their billing practices did not comport with Medicare requirements.
Patients reportedly described being treated like cattle at the clinic, per the complaint, spending minutes with providers and receiving unnecessary testing that was pushed onto patients if they wanted to receive their pain medications.
According to the DOJ, the government began investigating the wrongdoing alleged in the complaint in response to a lawsuit filed under the whistleblower provisions of the False Claims Act. Under those provisions, an individual can file an action on behalf of the U.S. and receive a portion of any recovery.
The matter is being investigated by the Department of Health and Human Services, Office of Inspector General, and the Department of Veterans Affairs, Office of Inspector General. Assistant U.S. Attorney Michael Tackeff represents the United States.
The actions described in the complaint are only allegations, and no determination of liability has been made, the DOJ stressed.
