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Federal Suit Alleges ‘Staggering’ Urine Drug Testing Fraud at Pain Clinics

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The Justice Department on Monday accused a defunct chain of Tennessee-based pain clinics of cheating Medicare and other taxpayer-funded health insurers out of at least $25 million in needless urine drug tests and genetic testing.

The civil lawsuit names Comprehensive Pain Special­ists, also known as Anesthesia Services Associates PLLC; four of its physician owners; and a former top executive. The doctors include Tennes­see Republican State Sen. Steven Dickerson and Peter Kroll, both anesthesiologists.

At its peak, CPS ran 60 pain clinics in a dozen states and treated some 48,000 patients per month, according to the suit. It shut down abruptly last summer, leaving many chron­ic pain patients scrambling to find a new source of narcotic medicines.

The Justice Department fraud case centers largely on the company’s lucrative urine-testing lab in Brentwood, Tenn., which CPS financed with a $1.5 million loan. The suit also alleges overbilling from acupuncture and other services offered to patients.

CPS was the subject of a No­vember 2017 investigation by Kaiser Health News that scru­tinized Medicare billings for urine drug tests.

Medicare and other fed­eral programs paid over $70 million from 2011 to 2018 for CPS-ordered urine tests, an amount the lawsuit called “staggering.” TennCare, the state’s Medicaid program, paid more than $9 million more dur­ing that time.

“For this reason, CPS con­sidered [urine tests] to be ‘liq­uid gold’ — with revenues of tens of millions of dollars for what was largely unnecessary medical testing,” according to the suit.

The chain’s owners and then-CEO John Davis “viewed every CPS patient as an oppor­tunity to make money, without regard to the individualized need for treatment,” the suit alleges. Davis was convicted last year in Nashville on fed­eral criminal health care fraud charges. He has since filed a motion for a new trial.

Dan Martin, an attorney representing Kroll, said in an emailed statement: “We are aware of the allegations and very familiar with the actual facts. Dr. Kroll did not engage in any wrongdoing whatsoev­er, and we look forward to cor­recting the government’s mis­understanding of the facts.”

Dickerson’s attorney, Ed Yarbrough, also issued a state­ment that read: “Dr. Dicker­son is an honest man. We will prove that in court.”

In its investigation, KHN, with assistance from research­ers at the Mayo Clinic, found that spending on urine screens and related genetic tests qua­drupled from 2011 to 2014 to an estimated $8.5 billion a year — more than the entire budget of the Environmental Protec­tion Agency. The federal gov­ernment paid medical provid­ers more to conduct urine drug tests in 2014 than it spent on the four most recommended cancer screenings combined.

CPS was among the nation’s most aggressive testers. KHN found that in 2014 five of its medical professionals stood among the nation’s top billers. Anita Bayles, a nurse practi­tioner working at a CPS clinic in Cleveland, Tenn., generated $1.1 million in urine-test bill­ings that year, according to Medicare records analyzed by KHN.

The Justice Department suit says that CPS believed Bayles ordered too many urine tests and overprescribed opioids and in September 2016 decid­ed to fire her. But the decision was reversed by CEO Davis “because of her ability to gen­erate revenues,” according to the suit. Bayles could not be reached for comment.

Though CPS ran six or more urine tests a year on many pa­tients receiving narcotics, its doctors often did not review the results to make sure pa­tients did not abuse them, ac­cording to the suit.

Kroll, who also served as CPS’ medical director, told KHN in 2017 that the high volume of tests was justified to keep patients safe and to reduce chances of black mar­ket sales of pills. Kroll billed Medicare $1.8 million for urine tests in 2015, the KHN analysis of Medicare billing records found.

Kroll said in a 2017 inter­view that he and Dickerson came up with the idea to open a high-quality pain practice over a cup of coffee at a Nash­ville Starbucks in 2005.

But the Justice Department alleges that CPS expanded rapidly through bilking the government, conduct that its top executives and founders “failed to take any action to stop,” according to the suit.

In what is called a “particu­larly egregious example of this fraudulent conduct,” the Justice Department alleged that Kroll caused over 2,500 claims to be submitted to Medicare, for which CPS was paid almost $350,000, during a 10-day period in May 2017 when Kroll was on vacation in Italy.

“Because of these fraudu­lent claims, Kroll’s billing privileges with Medicare have been revoked,” according to the suit.

The lawsuit states that Medicare officials began in­vestigating overcharging for urine testing at CPS in 2014 and eventually directed the company to repay the govern­ment $27.4 million in an ex­trapolated penalty. But CPS aggressively appealed the decision and managed to get it overturned and stay in busi­ness.

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Gov. Newsom Statement on Proposed $26 Billion National Opioid Settlement

“If approved, this settlement agreement would provide an important investment in opioid treatment and prevention. The agreement would also require the industry to make important changes to help combat this epidemic.”

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Pills on a spoon with a wooden bottom and white background; Photo courtesy of Michael Longmire via Unsplash

Governor Gavin Newsom released on July 21 the below statement on the proposed $26 billion settlement announced by California Attorney General Rob Bonta and state attorneys general across the country to resolve investigations and litigation over the role of major pharmaceutical companies in America’s devastating opioid epidemic.

The proposed settlement with opioid distributors Cardinal, McKesson and AmerisourceBergen and manufacturer Johnson & Johnson will provide relief for Americans suffering with addiction and includes important changes to the industry to combat the opioid epidemic.

“California strongly supports continued investment in combatting the devastation that our communities have suffered because of the opioid epidemic,” said Newsom. “The opioid epidemic continues to pose a serious threat to the health of Californians. In 2019, California experienced nearly 12,000 opioid-related emergency department visits and more than 3,000 deaths.

“If approved, this settlement agreement would provide an important investment in opioid treatment and prevention. The agreement would also require the industry to make important changes to help combat this epidemic.”

“We eagerly anticipate the finalizing of the proposed opioid settlement and partnering with local governments across California to leverage the funding that will help expand opioid prevention and treatment resources.”

This report is courtesy of Gov. Gavin Newsom’s press office. 

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African American News & Issues

Gwen Berry: “Activist Athlete” Tokyo Olympics 2021

Berry was formally reprimanded and put on 12-month probation by the U.S. Olympic Committee in 2019 for raising a fist after winning the gold medal at the Pan American Games in Lima, Peru.

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Gwen Berry, Photo courtesy Wikipedia

Gwen Berry is headed to Tokyo representing the United States at the 2021 Olympics in the hammer throw, a track and field event.

Berry, a two-time Olympian, was also in the 2016 Olympics in Rio.  She was born in St. Louis, Missouri in 1989 and is 32 years old.

On June 26, 2021, while qualifying for the U.S. Olympic team in Eugene Oregon, Berry was surprised to hear “The Star-Spangled Banner”, the U.S. National Anthem being played.

On the podium she turned away from the flag and draped her “Activist Athlete” tee-shirt over her head.

Berry said: “I feel like it was a set-up, and they did it on purpose. . .. I was pissed to be honest.”

Berry said she was told that the athletes would be on the podium before or after the playing of the national anthem.

“That’s what they’ve done the whole trials” Berry said.

Texas Republican politicians Senator Ted Cruz and Congressman Dan Crenshaw called for Berry to be removed from the USA Olympic team as she was unpatriotic.

Caitlyn Jenner, an Olympic decathlon winner in 1976 and candidate for California governor on the September 14th Newsom recall election in a statement said Berry’s actions were “disgusting” and to “stay out of politics” and not use the Olympic stage “for your own political gain.”

Berry responded: “I say Caitlyn Jenner does not know how it feels to be a Black person in American who’s representing a country [that] has literally done nothing for Black people in America.  She needs to do her research and understand the history in America before she says anything like that.

Berry was formally reprimanded and put on 12-month probation by the U.S. Olympic Committee in 2019 for raising a fist after winning the gold medal at the Pan American Games in Lima, Peru.

In June of 2020, the USOC supported peaceful protests and condemned “the systemic inequality that disproportionately impacts Black Americans.”

Berry tweeted “I want an apology letter. . . mailed . . . just like you and the IOC MAILED ME WHEN YOU PUT ME ON PROBATION. . . stop playing with me.”

Berry added to The Associated Press: “The anthem doesn’t speak for me.  It never has. . ..  I am here to represent those . . . who dies due to systemic racism.  That’s the important part.  That’s why I’m going.”

White House press secretary Jen Psaki said: “[p]art of that pride in our country means recognizing there are moments where we are, as a country, haven’t lived up to our highest ideals.  And it means respecting the rights of people granted to them in the Constitution to peacefully protest.”

The 2020 Summer Olympics delayed because of the pandemic will be held from July 23 to August 8, 2021, in Tokyo, Japan.

The New York Times, CNN, and Wikipedia were sources for this story.

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Community

Federal Judge Rules DACA Illegal; Immigrants Groups Urge Congress to Act on Immigration Reform

Hanen’s decision does not prevent existing DACA recipients from applying to renew their status, but it does prevent thousands of new applications from being able to apply moving forward.

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Political propaganda paper lying on the Westminster Bridge, London. Photo courtesy of Metin Ozer via Unsplash

A Texas federal judge ruled DACA illegal last week, partially suspending the crucial immigration program and halting all new applicants to it. President Biden called the decision “very disappointing” and said the Department of Justice would appeal it, while immigrants’ rights groups urged Congress to pass comprehensive immigration reform.

The ruling is the latest and perhaps most devastating development in the legal saga that has surrounded the program since former President Obama introduced it in 2012 after years of failed attempts at immigration reform. The program, which stands for Deferred Action for Childhood Arrivals, covers undocumented immigrants who were brought to the US by their parents as children, granting them temporary protection from deportation and allowing them to work. At least 650,000 people, known as Dreamers, are protected by the program, including about 200,000 in California, the largest number for any single state.

But conservatives have fought the program with legal challenges since its inception. No new DACA applicants were accepted for nearly three years under former President Donald Trump. Last summer, the Supreme Court blocked Trump from ending the program, calling his move to stop it “arbitrary and capricious.” The court did not rule on the legality of the program in general, however. Now, Texas judge Andrew Hanen has ruled that Obama overstepped his authority as president when he implemented the program, siding with Republican attorneys general who made that argument in their legal challenge. Hanen, a Republican appointee to the federal bench, was widely expected to rule against DACA.

 Hanen’s decision does not prevent existing DACA recipients from applying to renew their status, but it does prevent thousands of new applications from being able to apply moving forward.

Immigrants’ rights groups reacted to the ruling, slamming Hanen’s decision and calling on Congress and the Biden administration to finally pass comprehensive immigration reform. “This decision will spread fear and confusion throughout our workforce and our community, a community that has already been devastated by the impact of COVID-19, xenophobia, and the decision-making paralysis in Congress,” Texas-based group RAICES said in a statement. “Judge Hanen’s rash decision reiterates the immediate need for Congress and the Biden administration to keep their promise and create a pathway to citizenship for all undocumented people in the United States.”

“Today’s ruling is evidence that DACA is not enough,” Greisa Martinez Rosas, executive director of United We Dream, said in another statement. “The program has always been temporary, leaving hundreds of thousands of lives vulnerable to the next attack…. The only thing that can protect all immigrant youth, TPS holders, farm workers and other essential workers, is a path to citizenship through reconciliation. Until President Biden and Democrats in Congress deliver on citizenship, the lives of millions of undocumented people remain on the line. Democrats must pass a pathway to citizenship this year, no excuses!”

Senate Judiciary Chair Dick Durbin, one of the original sponsors of legislation to protect Dreamers, suggested that Democrats may now attempt to pass immigration reform on their own, without the support of Republicans.

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