KNOXVILLE, Tenn. – On June 26, Associated Pain Specialists, P.C., of Knoxville, a pain management based clinic, agreed to pay $400,000 to resolve allegations of violating the False Claims Act.
The settlement resolves allegations that from February 1, 2016 through August 10, 2018, Associated Pain Specialists, P.C. knowingly billed Medicare and Tennessee Medicaid (TennCare) for medically unnecessary screening tests at higher costs than appropriate, when less costly or alternative tests were available.
The government alleged that Associated Pain Specialists, P.C. performed tests on patients whose medical records did not support a medical diagnosis for the tests and the associated billing codes. The government also alleged the Vital System Assessment Tests (VSAT) did not benefit patients because the test results were not used in the treatment subsequently provided, and that, ultimately, Associated Pain Specialists, P.C. knowingly submitting false claims to federal health care programs for payment for VSATs that were not reasonable or medically necessary.
Allegations were brought in a lawsuit filed under the qui tam, or whistleblower, provisions of the False Claims Act, which permit private parties to sue on behalf of the government for false claims, and to receive a share of any recovery. The government may intervene and file its own complaint in such a lawsuit, as was done in this case.
“Medical providers have a duty to uphold ethical standards of care and to provide services when medically necessary in order to meet the professionally recognized standards of health care. Our office will continue to root out those who attempt to take advantage of government medical programs. Those who fail to comply with the law in order to increase profit will be pursued by the Department of Justice,” said U.S. Attorney J. Douglas Overbey.
“Patients benefit when they receive only medically necessary treatments – they deserve nothing less,” said Derrick L. Jackson, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services (HHS-OIG). “We will continue working with our Federal and State Law Enforcement partners to protect taxpayers and government health care beneficiaries.”
“This VSAT is one of many so-called medical devices that we are seeing across Tennessee and the nation that are fraudulently used with the sole purpose of generating revenue for a health care provider by conducting unnecessary and sometimes worthless tests,” said Tony Hullender, Deputy Attorney General of the Medicaid Fraud and Integrity Division.
As part of the settlement, Associated Pain Specialists, P.C., entered an Integrity Agreement (IA) with HHS-OIG which promotes its future compliance with the statutes, regulations, program requirements, and written directives of Medicare and all other federal health care programs. The IA focuses on the pain clinic’s continuing obligation to accurately bill and properly submit reimbursement claims to Medicare and TennCare.
This investigation resulted from a coordinated effort between the U.S. Attorneys’ Office for the Eastern District of Tennessee, HHS-OIG, and the Tennessee Attorney General’s Office, Medicaid Fraud and Integrity Division. Support was provided from HHS-OIG, the Tennessee Bureau of Investigation, and the Medicaid Fraud Control Division.
The case is docketed as United States and State of Tennessee ex rel. Cox. v. Associated Pain Specialist, P.C. and Smoky Mountain Ambulatory Surgery Center LLC., No. 3:18-cv-154.
Assistant U.S. Attorneys Jeremy Dykes and Margaret Harker represented the United States. Deputy Attorney General Tony Hullender represented the State of Tennessee.
The claim settled by this agreement are allegations only, and there has been no determination of liability.