Tennessee Chiropractor Pays More Than $1.45 Million To Resolve False Claims Act Allegations
Lawsuit Alleged Improper Billing To Medicare and TennCare For Painkillers - Including Opioids
A Lenior City, Tennessee, chiropractor has paid $1.45 million, plus interest, to resolve False Claims Act violations, announced U.S. Attorney General Jeff Sessions and U.S. Attorney Don Cochran of the Middle District of Tennessee. The settlement also calls for a Cookeville, Tennessee, pain clinic nurse practitioner to pay $32,000 and surrender her DEA registration to settle allegations that she violated the Controlled Substances Act.
Matthew Anderson and his management company, PMC LLC, managed four pain clinics in Tennessee, most recently known as; Cookeville Center for Pain Management; Spinal Pain Solutions in Harriman; Preferred Pain Center of Grundy County in Gruetli Laager; and McMinnville Pain Relief Center. All of these clinics are now closed.
“More Americans are dying because of drugs today than ever before—a trend that is being driven by opioids,” said Attorney General Jeff Sessions. “If we’re going to end this unprecedented drug crisis, which is claiming the lives of 64,000 Americans each year, 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. Today’s settlement is a positive step that will help save lives, as well as protect taxpayers’ money, in Tennessee and across the United States.”
“As evidenced here, we will use all available resources, including civil remedies, to pursue those whose actions continue to fuel the opioid epidemic plaguing our nation,” said U.S. Attorney Cochran. “In this case, a concerned whistleblower brought a civil suit 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. We will continue to give the highest priority to fighting opioid abuse on all fronts.”
The settlement with Anderson and PMC resolves the governments’ claims that from 2011 through 2014, they caused pharmacies to submit requests for Medicare and TennCare payments for pain killers, including opioids, which were dispensed based upon prescriptions written at the Cookeville Center for Pain Management and which had no legitimate medical purpose. The United States also contended that Anderson caused all four clinics to bill Medicare for upcoded claims for office visits that were not reimbursable at the levels sought. In addition, the United States claimed that Anderson and PMC caused the submission of Medicare claims by the Cookeville and Harriman clinics for services provided by two nurse practitioners who were not collaborating with a physician as required by Tennessee law during parts of 2011 and 2012.
Under the settlement agreement, Anderson and PMC paid a total of $1,450,000, plus interest. Of that amount, the United States will receive $1,040,275, and the State of Tennessee will receive $163,225. Anderson and PMC also agreed to be excluded from billing federal health care programs for five years. Three of the clinics will also forfeit $53,840, which the United States seized from the clinics’ bank accounts.
The settlement agreement also calls for Cindy Scott, a nurse practitioner from Nashville, to pay $32,000 and to surrender her DEA registration until October 2021. Scott is prohibited from prescribing medications until her DEA registration is renewed.
“The opioid epidemic has had a crushing effect on patients and families across middle Tennessee,” said Derrick L. Jackson, Special Agent in Charge of the U.S. Department of Health and Human Services Office of Inspector General in Atlanta. “Pill mills like these billed medically unnecessary services to Medicare and TennCare and contributed to problems of opioid abuse and addiction.”
The United States and Tennessee initiated this investigation after a former office manager for the Cookeville Center for Pain Management filed a qui tam lawsuit against Anderson, Scott, three pain clinics, and others. The qui tam, or whistleblower, provisions of the False Claims Act allow private citizens with knowledge of false claims to bring civil suits on behalf of the government and to share in any recovery. The whistleblower will receive $246,500 under the settlement with Anderson and lesser amounts under the settlements with Scott and the three pain clinics.
The case was handled by the United States Attorney’s Office for the Middle District of Tennessee and the Tennessee Attorney General’s Office and investigated by the Department of Health and Human Services - Office of Inspector General and the Tennessee Bureau of Investigation Medicaid Fraud Control Unit. Assistant U.S. Attorney Ellen Bowden McIntyre represented the United States, and Assistant Attorney General Philip Bangle represented the State of Tennessee.
The case is docketed as United States ex rel. Norris v. Anderson, No. 3:12-cv-00035 (M.D. Tenn.). The claims in the complaint are allegations only, and there has been no determination of liability.