Consumer Fraud

Whistleblower Key in Recovering $1.2 Million From Florida Pain Clinic

whistleblower Whistleblower Key in Recovering $1.2 Million From Florida Pain ClinicA doctor who filed a whistleblower lawsuit against a Jacksonville, Florida-based pain management clinic was instrumental in helping the U.S. government recover more than $1.2 million for Medicare, TRICARE, and other federally subsidized health care programs.

U.S. Attorney Maria Chapa Lopez of the Middle District of Florida said Riverside Spine & Pain Physicians agreed to pay the U.S. $1,204,415 to settle a complaint filed by Dr. Carissa Stone, a former employee of the clinic. Dr. Stone filed the lawsuit under the whistleblower provisions of the False Claims Act, alleging the clinic billed Medicare and other U.S. health care programs for unnecessary urine drug tests.

Federal officials investigated Dr. Stone’s allegations and determined that Riverside Spine & Pain billed the U.S. for costly quantitative drug tests, which identify and assess the amount of drugs in a patient’s urine, rather than simply testing for the presence of certain drugs.

Quantitative urine drug tests are necessary only if an individual patient assessment supports further testing, but using the tests for all patients is extremely expensive and unnecessary. Federal prosecutors said Riverside Pain & Spine performed quantitative testing on all of its patients for the same panel of drugs regardless of the individual patient’s history and risk.

The clinic then billed the government health care programs for the tests in violation of the False Claims Act.

Dr. Stone will receive about $240,000 of the settlement as a whistleblower award. The federal False Claims Act lets whistleblowers collect 15 to 25 percent of the total recovery resulting from a judgment or settlement their lawsuit brought about.

“This settlement highlights our commitment to hold accountable providers who place profits over patients,” said Shimon Richmond, Special Agent in Charge for the investigative arm of the U.S. Department of Health and Human Services. “Paying medically unnecessary claims or those stemming from improper referrals is an injustice to the Medicare program and the beneficiaries it serves.”