The U.S. Attorney’s Office for the Middle District of Florida announced on August 31, 2016 that a Florida pain management clinic has agreed to pay $7.4 million to the government to resolve allegations that it violated the False Claims Act by performing medically unnecessary drug screening procedures.
Quantitative Drug Tests Vs. Qualitative Drug Tests
The Florida pain management clinic was alleged to have performed unnecessary “Quantitative Drug Tests” that identify and count particles of illicit drugs in patients’ urine. The government alleged that quantitative drug tests are appropriate only if there is reason to doubt the more general and cheaper “qualitative” drug test screens because quantitative drug tests are very expensive and very specific. Nonetheless, the government alleged that the Florida pain management clinic performed and billed the government for quantitative drug tests for all of its patients which were medically unnecessary because there was no reason to question or further confirm the previous qualitative drug test screenings.
The Florida pain management clinic appeared on the government’s radar screen after review of its claims data suggested that its billings for quantitative drug test screens were a “statistical outlier.” The government allegedly discovered that the Florida pain management clinic billed for a quantitative drug test screen each time it billed for a qualitative drug test screen. As a result, the U.S. Department of Justice began an investigation into the Florida pain management clinic’s billing practices.
The U.S. Attorney for the Middle District of Florida stated in announcing the settlement, “The United States Attorney’s Office is committed to taking the steps necessary to protect Medicare, TRICARE, and other federal health care programs from fraud. When health care practitioners conduct medical tests, they must only bill for them when it is appropriate and medically necessary. We will vigorously pursue providers that perform tests indiscriminately, regardless of need.”
The U.S. Attorney’s Office emphasized that the claims resolved by this settlement are allegations only and there has been no determination of liability. It also noted that the Florida pain management clinic cooperated with the federal investigation and promptly agreed to resolve the allegations against it by the payment of the fine.
It is reported that the Florida pain management clinic operated clinics in the Jacksonville, Florida area and saw upwards of 200,000 patients per year. The $7.4 million fine represents double the amount that was billed for allegedly medically unnecessary tests between August 2015 and February 1, 2016.
Medicare promulgated new guidelines in mid-August 2015 after finding widespread billing for both qualitative drug screening and quantitative drug screening by many pain clinics, which is why the Florida pain management clinic’s fine was based on double the amount of billings that occurred since August 2015, after the new Medicare guidelines were implemented.
If your pain management treatment caused you to be injured or to suffer other harm, visit our website to be connected with medical malpractice lawyers in your U.S. state who may be able to assist you with a pain management medical malpractice claim against your pain management clinic. You may also call us toll-free in the United States at 800-295-3959.
Turn to us when you don’t know where to turn.