Insurance Fraud NEWS
Feds to sue Sen. Steve Dickerson and other pain clinic owners over fraud, forgery allegations
April 24, 2019, Nashville, TN
Federal and state prosecutors are moving to file lawsuits accusing Tennessee Sen. Steve Dickerson and other owners of a massive pain management company of defrauding the government with years of unjustified tests, dishonest billing and forged documents.
Their company, Comprehensive Pain Specialists, or CPS, allegedly profited so much from questionable drug tests that a corporate executive once said urine samples "smelled like money," according to newly unsealed federal court records.
Prosecutors revealed in those court records they plan to sue CPS by incorporating allegations from seven whistleblowers who filed secret complaints against the company over the past three years. Five of the whistleblowers are former employees who say they were fired from CPS after discovering wrongdoing within the company.
All allegations are civil. Prosecutors have not announced any intention to pursue criminal charges against CPS or its owners.
Dickerson, R-Nashville, an anesthesiologist who co-founded and co-owned CPS, will be a named defendant in at least one allegation, court documents state. Dickerson did not immediately respond to an email asking for comment on Tuesday night and declined to comment on CPS when questioned about the company earlier this month.
Other known defendants will include 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.
CPS was one of the largest pain management chains in the nation. The company once operated about 60 clinics across 11 states from its headquarters in Brentwood, but shut down last summer with little warning to patients and employees.
The 5 schemes feds allege against CPS:
Both federal and state attorneys plan to file a detailed complaints against CPS in the next three months. The court documents unsealed Tuesday say the lawsuits will accuse of the company of at least five schemes in violation of the False Claims Act:
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.
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.
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 documents to make it appeared those services had been performed by Kroll, the company medical director. Kroll’s signature was allegedly forged by copy-and-pasting it onto documents, and one whistleblower alleges she did so up to 45 times a day.
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."
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.
Health care fraud cases often originate with whistleblower lawsuits that are filed under seal against a company that is accused of defrauding the government. Government prosecutors intervene in the lawsuit if they feel the claims are legitimate.
In the CPS case, prosecutors decided to adopt allegations from seven whistleblowers in a single consolidated complaint. In light of this decision, U.S. District Court Judge Aleta Trauger on Tuesday ordered the whistleblower suits unsealed and told the state and federal government to file their