On April 16, 2021, the DOJ announced in a PRESS RELEASE that Preferred Pain Management & Spine Care, P.A. (“PPM”) and its owner, Dr. David Spivey, have agreed to pay $789,292.95 to resolve civil allegations that PPM violated the False Claims Act by billing Medicare, Medicaid, and other federal health care programs for medically unnecessary urine drug testing (“UDT”). The Relator/Whistleblower will receive $118,911.12 as her share of the federal recovery in this case.
According to the Qui Tam Relator’s Complaint filed on January 22, 2018, PPM ordered unnecessary confirmatory tests of urine and were reimbursed for these tests by the federal government. A copy of the Relator’s Complaint is below:
On October 18, 2019, the United States filed its Complaint in Intervention alleging, among other things, that:
(1) PPM, through Dr. Spivey, designed and executed a scheme to maximize profits from UDT by performing excessive amounts of UDT for essentially all patients (including those covered by Medicare, Medicaid and other federal health care programs) regardless of whether the UDT was reasonable and necessary for the diagnosis or treatment of any individual patient.
(2) PPM and Dr. Spivey were aware that Medicare only covers tests that are reasonable and necessary for the treatment and diagnosis of an individual patient’s illness or injury, based on his or her medical condition. The need for each test, for each patient, must be individually assessed and documented in the patient’s medical chart. Many patients, including those with chronic pain, do not need extensive laboratory-based UDT.
(3) At Dr. Spivey’s direction, PPM’s in-house laboratory nonetheless performed extensive and expensive UDT for all of PPM’s patients, regardless of whether the treating provider desired or ordered such testing. Contrary to industry standards, PPM simultaneously ordered both initial “screening” tests and confirmatory tests—even though the screening tests were not available at the time of the patient visits or otherwise used to determine whether confirmation testing was necessary at all. PPM then billed Medicare and other federal health care programs for both screening and confirmatory tests for numerous drugs or drug classes per urine sample, including tests for drugs that patients were not suspected of taking, and for unnecessary confirmation of expected results.
(4) PPM and Dr. Spivey knowingly submitted and caused to be submitted more than $1.5 million in false claims to federal health care programs, by billing or causing to be billed to federal health care programs claims for UDT that were not medically reasonable and necessary, in violation of the FCA.
A copy of the United States’ Complaint in Intervention is below:
Copies of the Notice of Settlement* and Stipulation of Dismissal are below:
*The settlement is not an admission of liability or wrongdoing by PPM or Dr. Spivey.