A former office manager for a Tennessee pain clinic filed a qui tam lawsuit under the federal False Claims Act accusing her former employer of falsely billing Medicare and TennCare for unnecessary painkillers, upcoding claims, and billing Medicare for improper nurse practitioner services. The federal government and the State of Tennessee brought suit and have just settled with a chiropractor, a nurse practitioner and several now-closed pain clinics. As a result of the whistleblower's actions, she will receive more than $246,500 -- a share in the total settlements.
According to the Justice Department, a Lenior City chiropractor, his four pain clinics, and a Cookeville nurse practitioner were all involved in the alleged scheme. The chiropractor managed four pain clinics in Tennessee: the Cookeville Center for Pain Management, Spinal Pain Solutions in Harriman, Preferred Pain Center of Grundy County, and McMinnville Pain Relief Center.
The DOJ basically accuses these clinics of being "pill mills." Between 2011 and 2014, the DOJ says, the chiropractor and his four pain clinics billed Medicare and TennCare for painkillers -- including opioids -- which served no legitimate medical purpose. In addition, the chiropractor and the clinics upcoded their billings for office visits. This means that they submitted claims for payment at higher levels than they actually deserved based on what was done during the visit.
Finally, the DOJ says the chiropractor and clinics billed Medicare for the services of two clinical nurse practitioners even though they were not collaborating with a physician, as is required by law.
"A concerned whistleblower brought a civil suit," says a U.S. Attorney, "which has ultimately held those responsible for the illicit prescribing of opioids and at the same time cheating the taxpayers by causing federal healthcare programs to pay for such highly addictive drugs."
The chiropractor and his four clinics (which are now closed) agreed to settle the allegations for a total of $1,450,000. The whistleblower will receive $245,500 of that total as a reward. Additional settlements were made with the clinics and one of the nurse practitioners, and the whistleblower will receive a share of those settlements, as well.
The chiropractor will not be allowed to bill any federal healthcare program for five years. The nurse practitioner will have to surrender her Drug Enforcement Administration registration until 2021 and cannot prescribe medication until that registration is renewed.
Referring to the "unprecedented" opioid crisis, Attorney General Jeff Sessions commented that, if the crisis is to end, "doctors must stop overprescribing opioids and law enforcement must aggressively pursue those medical professionals who act in their own financial interests, at the expense of their patients' best interests." He called the settlement a positive step.