UNITED STATES REACHES $37 MILLION SETTLEMENT OF FRAUD LAWSUIT AGAINST CIGNA FOR SUBMITTING FALSE AND INVALID DIAGNOSIS CODES TO ARTIFICIALLY INFLATE ITS MEDICARE ADVANTAGE PAYMENTS
NASHVILLE, Tenn. – May 20, 2020 – Franklin, Tennessee-based Rinova The Wellness Group, PC has settled the United States’ allegations that Medicare overpaid Rinova for claims that were non-payable due to fraudulent misrepresentations, announced U.S. Attorney Don Cochran for the Middle District of Tennessee. The government alleged that Rinova misrepresented that it had provided services, when they were actually a continuation of services by the suspended company Pain MD, LLC.
In 2019, Rinova, led by former Pain MD physician Ben Johnson, acquired certain Tennessee assets of Pain MD clinics and leased other Virginia assets of Pain MD clinics. At the time, Medicare contractors had suspended all payments to Pain MD, based on credible allegations of fraud. Rinova obtained new Medicare payment numbers, which according to the United States, amounted to an attempt to evade the Medicare payment suspension of Pain MD, so that Rinova could improperly obtain Medicare reimbursements while operating Pain MD’s Tennessee and Virginia pain clinics using the same Pain MD employees, clinics, locations, and patients.
The Medicare contractor suspended payments to Rinova in June 2019 and revoked Rinova’s billing privileges in September 2019. Rinova has now ceased its operations and no longer operates any pain clinics in Tennessee or elsewhere.
The settlement resolves the government’s claims that it overpaid Rinova for all of its services. Under the settlement agreement, Rinova waived its claim to $379,961 in suspended Medicare payments, forfeited $49,112, and paid an additional $53,151. The settlement has a total value of $482,224.
The matter was handled by the United States Attorney’s Office for the Middle District of Tennessee and investigated by the Tennessee Bureau of Investigation Medicaid Fraud Control Unit (TBI MFCU) and the Department of Health and Human Services, Office of Inspector General (HHS-OIG). Assistant U.S. Attorney Ellen Bowden McIntyre represented the United States.
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Public Information Officer