Government

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

Published

5 years ago

July 27, 2019

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.

Fred Schulte, Kaiser Health News

Posts by Fred Schulte, Kaiser Health News

Alameda County

DA Pamela Price Stands by Mom Who Lost Son to Gun Violence in Oakland

Last week, The Post published a photo showing Alameda County District Attorney Pamela Price with Carol Jones, whose son, Patrick DeMarco Scott, was gunned down by an unknown assailant in 2018.

Published

17 hours ago

April 22, 2024

Oakland Post

District Attorney Pamela Price with Carol Jones

Publisher’s note: Last week, The Post published a photo showing Alameda County District Attorney Pamela Price with Carol Jones, whose son, Patrick DeMarco Scott, was gunned down by an unknown assailant in 2018. The photo was too small for readers to see where the women were and what they were doing. Here we show Price and Jones as they complete a walk in memory of Scott. For more information and to contribute, please contact Carol Jones at 510-978-5517 at morefoundation.help@gmail.com. Courtesy photo.

Oakland Post

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Bay Area

MAYOR BREED ANNOUNCES $53 MILLION FEDERAL GRANT FOR SAN FRANCISCO’S HOMELESS PROGRAMS

San Francisco, CA – Mayor London N. Breed today announced that the U.S. Department of Housing and Urban Development (HUD) has awarded the city a $53.7 million grant to support efforts to renew and expand critical services and housing for people experiencing homelessness in San Francisco.

Published

3 days ago

April 20, 2024

Oakland Post

Mayor London Breed

FOR IMMEDIATE RELEASE:

Wednesday, January 31, 2024

Contact: Mayor’s Office of Communications, mayorspressoffice@sfgov.org

***PRESS RELEASE***

MAYOR BREED ANNOUNCES $53 MILLION FEDERAL GRANT FOR SAN FRANCISCO’S HOMELESS PROGRAMS

HUD’s Continuum of Care grant will support the City’s range of critical services and programs, including permanent supportive housing, rapid re-housing, and improved access to housing for survivors of domestic violence

San Francisco, CA – Mayor London N. Breed today announced that the U.S. Department of Housing and Urban Development (HUD) has awarded the city a $53.7 million grant to support efforts to renew and expand critical services and housing for people experiencing homelessness in San Francisco.

HUD’s Continuum of Care (CoC) program is designed to support local programs with the goal of ending homelessness for individuals, families, and Transitional Age Youth.

This funding supports the city’s ongoing efforts that have helped more than 15,000 people exit homelessness since 2018 through City programs including direct housing placements and relocation assistance. During that time San Francisco has also increased housing slots by 50%. San Francisco has the most permanent supportive housing of any county in the Bay Area, and the second most slots per capita than any city in the country.

“In San Francisco, we have worked aggressively to increase housing, shelter, and services for people experiencing homelessness, and we are building on these efforts every day,” said Mayor London Breed. “Every day our encampment outreach workers are going out to bring people indoors and our City workers are connecting people to housing and shelter. This support from the federal government is critical and will allow us to serve people in need and address encampments in our neighborhoods.”

The funding towards supporting the renewal projects in San Francisco include financial support for a mix of permanent supportive housing, rapid re-housing, and transitional housing projects. In addition, the CoC award will support Coordinated Entry projects to centralize the City’s various efforts to address homelessness. This includes $2.1 million in funding for the Coordinated Entry system to improve access to housing for youth and survivors of domestic violence.

“This is a good day for San Francisco,” said Shireen McSpadden, executive director of the Department of Homelessness and Supportive Housing. “HUD’s Continuum of Care funding provides vital resources to a diversity of programs and projects that have helped people to stabilize in our community. This funding is a testament to our work and the work of our nonprofit partners.”

The 2024 Continuum of Care Renewal Awards Include:

$42.2 million for 29 renewal PSH projects that serve chronically homeless, veterans, and youth
$318,000 for one new PSH project, which will provide 98 affordable homes for low-income seniors in the Richmond District
$445,00 for one Transitional Housing (TH) project serving youth
$6.4 million dedicated to four Rapid Rehousing (RRH) projects that serve families, youth, and survivors of domestic violence
$750,00 for two Homeless Management Information System (HMIS) projects
$2.1 million for three Coordinated Entry projects that serve families, youth, chronically homeless, and survivors of domestic violence

In addition, the 2023 CoC Planning Grant, now increased to $1,500,000 from $1,250,000, was also approved. Planning grants are submitted non-competitively and may be used to carry out the duties of operating a CoC, such as system evaluation and planning, monitoring, project and system performance improvement, providing trainings, partner collaborations, and conducting the PIT Count.

“We are very appreciative of HUD’s support in fulfilling our funding request for these critically important projects for San Francisco that help so many people trying to exit homelessness,” said Del Seymour, co-chair of the Local Homeless Coordinating Board. “This funding will make a real difference to people seeking services and support in their journey out of homelessness.”

In comparison to last year’s competition, this represents a $770,000 increase in funding, due to a new PSH project that was funded, an increase in some unit type Fair Market Rents (FMRs) and the larger CoC Planning Grant. In a year where more projects had to compete nationally against other communities, this represents a significant increase.

Nationally, HUD awarded nearly $3.16 billion for over 7,000 local homeless housing and service programs including new projects and renewals across the United States.

Oakland Post

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Business

Black Business Summit Focuses on Equity, Access and Data

The California African American Chamber of Commerce hosted its second annual “State of the California African American Economy Summit,” with the aim of bolstering Black economic influence through education and fellowship. Held Jan. 24 to Jan. 25 at the Westin Los Angeles Airport Hotel, the convention brought together some of the most influential Black business leaders, policy makers and economic thinkers in the state. The discussions focused on a wide range of economic topics pertinent to California’s African American business community, including policy, government contracts, and equity, and more.

Published

3 days ago

April 20, 2024

Oakland Post

Toks Omishakin, Secretary of the California State Transportation Agency (CALSTA), answers questions from concerned entrepreneurs frustrated with a lack of follow-up from the state. January 24, 2024 at the Westin Los Angeles Airport Hotel, Lost Angeles, Calif. Photo by Solomon O. Smith

By Solomon O. Smith, California Black Media

The California African American Chamber of Commerce hosted its second annual “State of the California African American Economy Summit,” with the aim of bolstering Black economic influence through education and fellowship.

Held Jan. 24 to Jan. 25 at the Westin Los Angeles Airport Hotel, the convention brought together some of the most influential Black business leaders, policy makers and economic thinkers in the state. The discussions focused on a wide range of economic topics pertinent to California’s African American business community, including policy, government contracts, and equity, and more.

Toks Omishakin, Secretary of the California State Transportation Agency (CALSTA) was a guest at the event. He told attendees about his department’s efforts to increase access for Black business owners.

“One thing I’m taking away from this for sure is we’re going to have to do a better job of connecting through your chambers of all these opportunities of billions of dollars that are coming down the pike. I’m honestly disappointed that people don’t know, so we’ll do better,” said Omishakin.

Lueathel Seawood, the president of the African American Chamber of Commerce of San Joaquin County, expressed frustration with obtaining federal contracts for small businesses, and completing the process. She observed that once a small business was certified as DBE, a Disadvantaged Business Enterprises, there was little help getting to the next step.

Omishakin admitted there is more work to be done to help them complete the process and include them in upcoming projects. However, the high-speed rail system expansion by the California High-Speed Rail Authority has set a goal of 30% participation from small businesses — only 10 percent is set aside for DBE.

The importance of Diversity, Equity and Inclusion (DEI) in economics was reinforced during the “State of the California Economy” talk led by author and economist Julianne Malveaux, and Anthony Asadullah Samad, Executive Director of the Mervyn Dymally African American Political and Economic Institute (MDAAPEI) at California State University, Dominguez Hills.

Assaults on DEI disproportionately affect women of color and Black women, according to Malveaux. When asked what role the loss of DEI might serve in economics, she suggested a more sinister purpose.

“The genesis of all this is anti-blackness. So, your question about how this fits into the economy is economic exclusion, that essentially has been promoted as public policy,” said Malveaux.

The most anticipated speaker at the event was Janice Bryant Howroyd known affectionately to her peers as “JBH.” She is one of the first Black women to run and own a multi-billion-dollar company. Her company ActOne Group, is one of the largest, and most recognized, hiring, staffing and human resources firms in the world. She is the author of “Acting Up” and has a profile on Forbes.

Chairman of the board of directors of the California African American Chamber of Commerce, Timothy Alan Simon, a lawyer and the first Black Appointments Secretary in the Office of the Governor of California, moderated. They discussed the state of Black entrepreneurship in the country and Howroyd gave advice to other business owners.

“We look to inspire and educate,” said Howroyd. “Inspiration is great but when I’ve got people’s attention, I want to teach them something.”