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Catch of the Week — Comprehensive Pain Specialists Targeted for Urine Drug Testing Fraud

Posted  July 26, 2019

Our Catch of the Week goes to Comprehensive Pain Specialists (CPS), a now-shuttered pain-management chain that was once one of the largest in the nation, treating as many as 48,000 pain patients a month at about 60 clinics across 11 states.  CPS shut down in 2018 with little warning to patients and employees.

On Monday, July 22, the United States and the State of Tennessee announced their partial intervention in five whistleblower actions under the False Claims Act that raised serious kickback and fraud allegations against CPS for laboratory and diagnostic services fraud, billing fraud, and billing for medically unnecessary services.  Defendants in the case will include Tennessee state Senator Steve Dickerson, an anesthesiologist who co-founded CPS in 2005; former CPS CEO John Davis, who was recently convicted of health care fraud in another case; and CPS co-owners Dr. Peter Kroll, Dr. Richard Muench, and Dr. Gilberto Carrero.

The governments allege that CPS defrauded Medicare and Medicaid of over $25 million by providing medically unnecessary and excessive urine drug testing, which, according to the government’s complaint, CPS commonly referred to as “‘liquid gold’ — leaving no doubt that profit was defendants’ primary objective in performing urine drug testing.”

In April, when the governments announced plans to file detailed complaints against CPS, they detailed five CPS schemes that violated the False Claims Act:

  1. Unnecessary, costly “full panel” tests at every visit.  CPS allegedly pressured employees to conduct unnecessarily expensive urine tests on patients so it could inflate billings to Medicare and Medicaid. CPS conducted “full panel” drug tests on every patient at every visit, despite cheaper tests being standard practice once a patient becomes a regular at the clinic. CPS incentivized doctors to order the tests by paying them a share of laboratory revenue.
  2. Unnecessary genetic and psychological tests.  CPS allegedly followed a similar model with genetic and psychological tests, which were ordered with unjustifiable frequency merely to increase profits. Nurse practitioners and physicians’ assistants were paid bonuses of $5 to $25 for every test they ordered.
  3. Services by unlicensed personnel. CPS allegedly allowed doctors and nurse practitioners to perform medical services in states where they weren’t licensed or at hospitals where they weren’t credentialed, then forged the signature of the company’s medical director, allegedly copying-and-pasting it onto documents.  One whistleblower alleged she forged the medical director’s signature up to 45 times a day.
  4. Unapproved treatment.  CPS treated patients with acupuncture devices known as “P-Stims” that were not covered by Medicare and Medicaid, but then billed the government as if they were using a completely different device called an “implantable electroneutral simulator.”
  5. Upcoding bills.  CPS allegedly “upcoded” visits with patients – pretending the visits were longer and more complex than they really were – so they could receive higher reimbursement rates from government insurance. CPS memos supposedly threatened that medical staff would loses bonuses or face disciplinary action if they documented visits in a way that led to lower reimbursement.

CPS was the subject of a November 2017 investigation by Kaiser Health News that scrutinized its Medicare billings for urine drug testing. Medicare paid the company at least $11 million for urine screenings and related tests in 2014, when five of CPS’ medical professionals stood among the nation’s top such Medicare billers. One nurse practitioner at a CPS clinic in Cleveland, Tenn., generated $1.1 million in urine-test billing that year, according to Medicare records analyzed by KHN.

The governments’ partial intervention will consolidate allegations brought by several whistleblowers who filed sealed lawsuits against CPS over the past three years.  According to court records, the courageous whistleblowers include:

  • Dr. Suzanne Alt, a doctor who worked at CPS clinics in Troy, Missouri and Keokuk, Iowa in 2015. Alt was one of several whistleblowers who reported to authorities that CPS was inflating its bills to Medicaid and Medicare by performing unnecessary an exorbitant drug tests at its lab in Brentwood, Tennessee.
  • Dana Brown, a radiology scheduler who worked for CPS in 2014, handling scheduling and paperwork for radiology services. Brown alleged CPS pressured her to forge the signature of the company medical director, Dr. Peter Kroll, to make it appear he had performed radiology services that were in fact done by other medical professionals who were not properly licensed or credentialed. Brown alleges she was later instructed to destroy all the forged documents.
  • Mary Butner, an insurance specialist for CPS who worked at the company office in Gallatin, Tennessee from 2012 until she was fired in 2016. Butner make the same allegations as Brown but provides one key extra detail – she says she was required to forge Kroll’s signature about 45 times a day.
  • Jennifer Pressotto, CPS’s director of compliance, who was tasked with ensuring that the company followed health care law. Pressotto alleges in her whistleblower compliant that she discovered the company was intentionally mislabeling non-covered medical devices during billings to deceive the government into paying for the devices.
  • Allison Chancellor, a physician’s assistant who worked at the CPS clinic in Alton, Illinois from February 2015 to June 2015. Chancellor’s complaint alleges that CPS used unnecessary and excessive drug tests, psychological testing, and genetic testing to inflate its profits and defraud the government.

As the allegations and breadth of whistleblower perspectives in this case demonstrate, the vigilant and discerning eyes of healthcare and administrative professionals are essential in combating the increasing number of alleged frauds involving medical testing, given the strong incentives unethical providers have to bilk the government.

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Tagged in: Anti-Kickback and Stark, Bundling and Unbundling, Catch of the Week, FCA Federal, Healthcare Fraud, Improper Medical Personnel, Laboratory and IDTF, Lack of Medical Necessity, Medical Billing Fraud, Whistleblower Case,