Government

Federal Suit Alleges ‘Staggering’ Urine Drug Testing Fraud at Pain Clinics

Published

5 years ago

July 27, 2019

The Justice Department on Monday accused a defunct chain of Tennessee-based pain clinics of cheating Medicare and other taxpayer-funded health insurers out of at least $25 million in needless urine drug tests and genetic testing.

The civil lawsuit names Comprehensive Pain Specialists, also known as Anesthesia Services Associates PLLC; four of its physician owners; and a former top executive. The doctors include Tennessee Republican State Sen. Steven Dickerson and Peter Kroll, both anesthesiologists.

At its peak, CPS ran 60 pain clinics in a dozen states and treated some 48,000 patients per month, according to the suit. It shut down abruptly last summer, leaving many chronic pain patients scrambling to find a new source of narcotic medicines.

The Justice Department fraud case centers largely on the company’s lucrative urine-testing lab in Brentwood, Tenn., which CPS financed with a $1.5 million loan. The suit also alleges overbilling from acupuncture and other services offered to patients.

CPS was the subject of a November 2017 investigation by Kaiser Health News that scrutinized Medicare billings for urine drug tests.

Medicare and other federal programs paid over $70 million from 2011 to 2018 for CPS-ordered urine tests, an amount the lawsuit called “staggering.” TennCare, the state’s Medicaid program, paid more than $9 million more during that time.

“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,” according to the suit.

The chain’s owners and then-CEO John Davis “viewed every CPS patient as an opportunity to make money, without regard to the individualized need for treatment,” the suit alleges. Davis was convicted last year in Nashville on federal criminal health care fraud charges. He has since filed a motion for a new trial.

Dan Martin, an attorney representing Kroll, said in an emailed statement: “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 attorney, Ed Yarbrough, also issued a statement that read: “Dr. Dickerson is an honest man. We will prove that in court.”

In its investigation, KHN, with assistance from researchers at the Mayo Clinic, found that spending on urine screens and related genetic tests quadrupled from 2011 to 2014 to an estimated $8.5 billion a year — more than the entire budget of the Environmental Protection Agency. The federal government paid medical providers more to conduct urine drug tests in 2014 than it spent on the four most recommended cancer screenings combined.

CPS was among the nation’s most aggressive testers. KHN found that in 2014 five of its medical professionals stood among the nation’s top billers. Anita Bayles, a nurse practitioner working at a CPS clinic in Cleveland, Tenn., generated $1.1 million in urine-test billings that year, according to Medicare records analyzed by KHN.

The Justice Department suit says that CPS believed Bayles ordered too many urine tests and overprescribed opioids and in September 2016 decided to fire her. But the decision was reversed by CEO Davis “because of her ability to generate revenues,” according to the suit. Bayles could not be reached for comment.

Though CPS ran six or more urine tests a year on many patients receiving narcotics, its doctors often did not review the results to make sure patients did not abuse them, according to the suit.

Kroll, who also served as CPS’ medical director, told KHN in 2017 that the high volume of tests was justified to keep patients safe and to reduce chances of black market sales of pills. Kroll billed Medicare $1.8 million for urine tests in 2015, the KHN analysis of Medicare billing records found.

Kroll said in a 2017 interview that he and Dickerson came up with the idea to open a high-quality pain practice over a cup of coffee at a Nashville Starbucks in 2005.

But the Justice Department alleges that CPS expanded rapidly through bilking the government, conduct that its top executives and founders “failed to take any action to stop,” according to the suit.

In what is called a “particularly egregious example of this fraudulent conduct,” the Justice Department alleged that Kroll caused over 2,500 claims to be submitted to Medicare, for which CPS was paid almost $350,000, during a 10-day period in May 2017 when Kroll was on vacation in Italy.

“Because of these fraudulent claims, Kroll’s billing privileges with Medicare have been revoked,” according to the suit.

The lawsuit states that Medicare officials began investigating overcharging for urine testing at CPS in 2014 and eventually directed the company to repay the government $27.4 million in an extrapolated penalty. But CPS aggressively appealed the decision and managed to get it overturned and stay in business.

Fred Schulte, Kaiser Health News

Posts by Fred Schulte, Kaiser Health News

Activism

U.S. House Minority Leader Hakeem Jeffries Speaks on Democracy at Commonwealth Club

Based on his first speech as House minority leader, “The ABCs of Democracy” by Grand Central Publishing is an illustrated children’s book for people of all ages. Each letter contrasts what democracy is and isn’t, as in: “American Values over Autocracy”, “Benevolence over Bigotry” and “The Constitution over the Cult.”

Published

1 day ago

December 22, 2024

Oakland Post

: House Minority Leader Hakeem Jeffries at the Commonwealth Club World Affairs Council on Dec. 2. Photo by Johnnie Burrell. Book cover: "The ABCs of Democracy" by Hakeem Jeffries.

By Linda Parker Pennington
Special to The Post

House Minority Leader Hakeem Jeffries addressed an enthusiastic overflow audience on Monday at San Francisco’s Commonwealth Club, launching his first book, “The ABCs of Democracy.”

Based on his first speech as House minority leader, “The ABCs of Democracy” by Grand Central Publishing is an illustrated children’s book for people of all ages.

Each letter contrasts what democracy is and isn’t, as in: “American Values over Autocracy”, “Benevolence over Bigotry” and “The Constitution over the Cult.”

Less than a month after the election that will return Donald Trump to the White House, Rep. Jeffries also gave a sobering assessment of what the Democrats learned.

“Our message just wasn’t connecting with the real struggles of the American people,” Jeffries said. “The party in power is the one that will always pay the price.”

On dealing with Trump, Jeffries warned, “We can’t fall into the trap of being outraged every day at what Trump does. That’s just part of his strategy. Remaining calm in the face of turmoil is a choice.”

He pointed out that the razor-thin margin that Republicans now hold in the House is the lowest since the Civil War.

Asked what the public can do, Jeffries spoke about the importance of being “appropriately engaged. Democracy is not on autopilot. It takes a citizenry to hold politicians accountable and a new generation of young people to come forward and serve in public office.”

With a Republican-led White House, Senate, House and Supreme Court, Democrats must “work to find bi-partisan common ground and push back against far-right extremism.”

He also described how he is shaping his own leadership style while his mentor, Speaker-Emeritus Nancy Pelosi, continues to represent San Francisco in Congress. “She says she is not hanging around to be like the mother-in-law in the kitchen, saying ‘my son likes his spaghetti sauce this way, not that way.’”

Oakland Post

Posts by Oakland Post

Activism

MacArthur Fellow Dorothy Roberts’ Advocates Restructure of Child Welfare System

Roberts’s early work focused on Black women’s reproductive rights and their fight for reproductive justice. In “Killing the Black Body: Race, Reproduction, and the Meaning of Liberty 1997)”, she analyzes historical and contemporary policies and practices that denied agency to Black women and sought to control their childbearing—from forced procreation during slavery, to coercive sterilization and welfare reform—and advocates for an expanded understanding of reproductive freedom.

Published

1 day ago

December 22, 2024

Oakland Post

Dorothy Roberts. Photo courtesy of the John D. and Catherine T. MacArthur Foundation.

Special to The Post

When grants were announced Oct. 1, it was noted that eight of the 22 MacArthur Fellows were African American. Among the recipients of the so-called ‘genius grants’ are scholars, visual and media artists a poet/writer, historian, and dancer/choreographer who each receive $800,000 over a five-year period to spend as they see fit.

Their names are Ruha Benjamin, Jericho Brown, Tony Cokes, Jennifer L. Morgan, Ebony G. Patterson, Shamel Pitts, Jason Reynolds, and Dorothy Roberts. This is the eighth and last in the series highlighting the Black awardees. The report below on Dorothy Roberts is excerpted from the MacArthur Fellows web site.

A graduate of Yale University with a law degree from Harvard, Dorothy Roberts is a legal scholar and public policy researcher exposing racial inequities embedded within health and social service systems.

Sine 2012, she has been a professor of Law and Sociology, and on the faculty in the department of Africana Studies at the University of Pennsylvania.

Roberts’s work encompasses reproductive health, bioethics, and child welfare. She sheds light on systemic inequities, amplifies the voices of those directly affected, and boldly calls for wholesale transformation of existing systems.

This work prompted Roberts to examine the treatment of children of color in the U.S. child welfare system.

After nearly two decades of research and advocacy work alongside parents, social workers, family defense lawyers, and organizations, Roberts has concluded that the current child welfare system is in fact a system of family policing with alarmingly unequal practices and outcomes. Her 2001 book, “Shattered Bonds: The Color of Child Welfare,” details the outsized role that race and class play in determining who is subject to state intervention and the results of those interventions.

Through interviews with Chicago mothers who had interacted with Child Protective Services (CPS), Roberts shows that institutions regularly punish the effects of poverty as neglect.

CPS disproportionately investigates Black and Indigenous families, especially if they are low-income, and children from these families are much more likely than white children to be removed from their families after CPS referral.

In “Torn Apart: How the Child Welfare System Destroys Black Families—and How Abolition Can Build a Safer World (2022),” Roberts traces the historical, cultural, and political forces driving the racial and class imbalance in child welfare interventions.

These include stereotypes about Black parents as negligent, devaluation of Black family bonds, and stigmatization of parenting practices that fall outside a narrow set of norms.

She also shows that blaming marginalized individuals for structural problems, while ignoring the historical roots of economic and social inequality, fails families and communities.

Roberts argues that the engrained oppressive features of the current system render it beyond repair. She calls for creating an entirely new approach focused on supporting families rather than punishing them.

Her support for dismantling the current child welfare system is unsettling to some. Still, her provocation inspires many to think more critically about its poor track record and harmful design.

By uncovering the complex forces underlying social systems and institutions, and uplifting the experiences of people caught up in them, Roberts creates opportunities to imagine and build more equitable and responsive ways to ensure child and family safety.