Whistleblowers play a huge part in keeping our industries honest, and nowhere is their dedication more important than in the medical industry. Without their oversight and action, billions of dollars may end up wasted, as shown by a recent suit against a pain management chain.
Federal lawsuits accuse Comprehensive Pain Specialists (CPS) of committing at least five different forms of fraud. They also draw attention toward the rapid rise of urine testing and the ways fraudulent testing may be increasing the costs of health care.
CPS accused of widespread fraud
CPS and its use of urine testing came under fire when a 2017 Kaiser Health News report tracked the incredible increase in the number of urine tests Medicare was asked to cover. In just nine years, the tests rose from a relative handful to nearly 20 million. In 2018, the tests cost U.S. taxpayers an estimated $8.5 billion.
The lawsuits claim CPS contributed to these costs with fraudulent billing practices. The company allegedly forced employees to order unnecessary tests and falsify their billing codes to increase the value of their insurance claims:
- Expensive urine drug screening tests, when standard practice called for cheaper tests
- Genetic and psychological tests ordered with “unjustifiable frequency”
- Signatures forged on bills to hide services performed by doctors in states where they were not licensed
- The use of different device names for treatments performed with ineligible devices
- Upcoding visits to make them appear longer, more complex and more expensive
CPS reportedly offered bonuses to employees who continued these practices and threatened those who objected with reduced pay and disciplinary measures. Thanks to the people who came forward, CPS is now facing its day in court, and for that reason the law offers powerful protections to those with the courage to stand up.
Criminal charges may follow
The suits against CPS might not be the end of the story. While the U.S. Attorney’s Office for the Middle District of Tennessee would neither confirm nor deny that it was pursuing criminal charges, its spokesman confirmed that prosecutors were still looking into the whistleblowers’ reports.