A chiropractic management company operating four pain clinics in Tennessee has agreed to settle a whistleblower lawsuit involving opioid prescriptions. A former office manager for the chiropractic and pain management company noticed medical and billing discrepancies. The worker brought the information forward in a whistleblower lawsuit filed under the federal False Claims Act (FCA).
Unnecessary Prescriptions and Upcoding Discovered
The lawsuit alleged, among other things, that four clinics issued prescriptions for medications without any medical purpose. Essentially, the clinics operated as pill mills, distributing medications without a proper medical need. The clinics then fraudulently sought reimbursement for the drugs from Medicare and the state. The lawsuit also says that the clinics used a practice known as “upcoding” to seek higher reimbursements from state and federal healthcare agencies than were justified for the services provided.
Access to opioids and opioid abuse are growing concerns in Wisconsin and at the national level. The issue is not confined to any single state, as we discussed last September. Federal and state officials believe that because whistleblowers have their ears to the ground, they often have access to discovering both Medicare fraud and information that can help to end the opioid abuse epidemic. A special agent for the inspector general, Derrick L. Jackson, stated in a Department of Justice press release, “Pill mills like these billed medically unnecessary services to Medicare and TennCare and contributed to problems of opioid abuse and addiction.”
Whistleblowers May Share in any Recovery of Taxpayer Money
Whistleblowers are allowed under the FCA to file a lawsuit on behalf of the government when there is evidence of fraud in any kind of government contract. Those who come forward with evidence receive a portion of any settlement or verdict that results from the litigation. In the recent case in the south, the former office manager will receive $246,500 in the settlement with the owner of the healthcare management company, and additional amounts in settlements with the individual clinics and a nurse practitioner at one of the clinics. Taxpayers will also benefit from the settlement. Medicare will recoup $1,040,275 and the Tennessee will regain $163,225 in taxpayer money that was fraudulently obtained through the scheme.