A Tennessee chiropractor who allegedly prescribed opioids with no legitimate medical purpose through his four pain clinics and then billed Medicare and Medicaid for them will pay the U.S. more than $1.45 million plus interest to settle the accusations, which were initiated by a whistleblower under the False Claims Act.
The U.S. Department of Justice said that from 2011 through 2014, Lenior City chiropractor Matthew Anderson and his management company PMC LLC, which managed four now-defunct pain clinics, wrote opioid prescriptions for patients who had no legitimate need for them. The patients, many of them Medicare and Medicaid beneficiaries, had the opioid prescriptions filled, thereby causing the pharmacies that dispensed the drugs to submit false claims to Medicare and Medicaid.
The U.S. also contended that Dr. Anderson caused all four of his clinics to upcode Medicare claims for office visits that were not reimbursable at the levels he sought, among other allegations. The U.S. government said that these practices occurred over a four-year period starting in 2011 and continuing through 2014.
Under the settlement agreement, Dr. Anderson and PMC paid a total of $1,450,000 plus an unspecified amount of interest. The federal government received $1,040,275 of the recovery and the State of Tennessee will receive $163,225. Dr. Anderson and PMC also agreed to be excluded from billing federal health care programs for five years. Three of the clinics have also forfeited $53,840, which the federal authorities 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. Ms. Scott is prohibited from prescribing medications until the DEA sees fit to renew her registration. According to the DOJ, Ms. Scott was prescribing opioid painkillers for a PMC pain clinic.
“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 Don Cochran of the Middle District of Tennessee. “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 health care programs to pay for such highly addictive drugs. We will continue to give the highest priority to fighting opioid abuse on all fronts.”
The U.S. and Tennessee initiated this investigation after a former office manager for one of Dr. Anderson’s pain clinics filed a lawsuit under the whistleblower provisions of the False Claims Act, which 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 Dr. Anderson in addition to part of the recoveries from the related settlements.