Ouch! Pain Clinic Chain Loses Whistleblower Case

Slap on the Wrist?

Attorney Markey, who represents the whistleblower O’Connor, told OTW that the size of the settlement was not what had been anticipated. While the complaint described many claims, “ultimately, the settlement achieved focuses on a subset of defendants and allegations, and in particular…billing of physician assistants, the claims related to anti-kickback/Stark violations, and lastly claims that relate to unnecessary quantitative drug testing.”

“Even though the relator wanted to pursue the remaining defendants and numerous claims on her own, once the government reached a settlement with PMA and NSPC, the government stated that it would move to dismiss those defendants and claims in order to preserve the settlement it had reached with PMA and NSPC. Under those circumstances, and considering the defendants and the specific conduct covered by the settlement, the terms of the settlement reached with PMA and NSPC were fair and reasonable.”

Recent Pain Clinic Billing Fraud Cases

“Pain Clinics’ Doctors Needlessly Tested Hundreds Of Urine Samples, Court Records Show.”

An April 24, 2019 news report under that headline in Kaiser Health News said that a Tennessee-based chain of pain clinics which closed abruptly last summer has been accused in five whistleblower lawsuits of precisely the same activity as one of the allegations in the NSPC lawsuit: massively billing for unnecessary drug screening tests.

“Fort Myers Pain Management Physician Pleads Guilty to Healthcare Offenses and Agrees to $2.8 Million Civil Settlement With the United States”

On June 4, 2018 The U.S. Attorney’s Office for the Middle District of Florida issued a press release saying that Fort Myers Dr. Michael Frey, M.D. “agreed to a civil settlement under which he will pay $2.8 million to the United States to resolve allegations that he violated the False Claims Act in a number of ways, including receiving illegal kickbacks and by ordering medically unnecessary laboratory tests.”

“Syracuse Area Medical Practice to Pay Nearly $2 Million to Resolve False Claims Act Exposure”

An October 3, 2017 U.S. Justice Department news release said the Syracuse-based pain management and spine procedure clinic New York Anesthesiology Medical Specialties, P.C. d/b/a New York Spine and Wellness Center (New York Spine & Wellness) “agreed today to pay $1,941,850.29 to resolve claims that it improperly billed for moderate sedation services.”

“Liquid gold: Pain doctors soak up profits by screening urine for drugs”

Modern Healthcare reported on November 7, 2017:

“Millennium encouraged doctors to order more tests both as a way to lower patients’ risks and to shield the physicians against possible investigations by law enforcement or medical licensing boards, according to court filings. Millennium denied the allegations in the whistleblower suits and settled all of them with the Justice Department in 2015 by agreeing to pay $256 million; its parent company, Millennium Lab Holdings II, declared bankruptcy.”

“Coastal Spine and Pain Pays $7.4 Million to Settle False Claims Charges”

Walter Eisner of Orthopedics This Week reported in September 2016, “Physicians Group Services, P.A., doing business as Coastal Spine and Pain based in Jacksonville, Florida, agreed to pay $7.4 million to the government to resolve allegations that Coastal violated the False Claims Act by performing medically unnecessary drug screening procedures.”

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[1] *Assaf T. Gordon, MD, a cofounder of Capitol Spine, who oversaw billing, compliance, and physician assistants before the merger, and who became a member of the NSPC board of directors afterward.