The United States government has lodged a False Claims Act complaint against the Clarksville Pain Institute, LLC, the Pain Institute of Nashville, PLC, and individuals Michael and Debbie Cox, as reported by the U.S. Department of Justice. The intervention, announced by Acting U.S. Attorney Thomas J. Jaworski for the Middle District of Tennessee, includes additional common law claims of unjust enrichment and payment by mistake. The Department of Justice detailed that since at least 2014, the defendants have purportedly submitted false claims for unnecessary diagnostic testing services such as urine drug screens, allergy tests, and psychological tests.
The complaint imparts a troubling portrayal of the Coxes' operations, accusing them of exerting pressure on staff to bill exorbitantly for diagnostic services not dictated by medical necessity while running multiple schemes to heighten testing profits, which included often disregarding the results of the routine urine tests they pressured patients to undergo. Despite receiving multiple warnings from consultants, auditors, and insurers about the discrepancies in their billing methods and Medicare requirements, the defendants continued their questionable practices, which also featured expeditious patient consultations, likened to a cattle herd treatment, where patients received unnecessary testing as a prerequisite for pain medication.
It was a qui tam, or whistleblower, lawsuit that blew the whistle on these alleged practices, which allows private parties to sue on behalf of the government and potentially receive a share of any financial restitution, the investigation has since been conducted by the Department of Health and Human Services, Office of Inspector General, as well as the Department of Veterans Affairs, Office of Inspector General, Assistant U.S. Attorney Michael Tackeff is currently representing the United States in this action.
The impact of such schemes, as delineated in the government's 70-page complaint, paints a stark picture of the healthcare system being exploited for profit at the expense of both the government and patients seeking genuine pain relief, the plaintiffs allege they were treated as commodities in a transaction where their health was secondary to the clinic's revenue stream, with many unaware of the unnecessary medical protocols they were subjected to.
