his one is pretty straightforward. Doctor owns pain clinic. Incidentally, that’s should be the first red flag.
Doctor also owns an in-house lab to test urine. That lab doesn’t really do any other business–it would fail unless doctor sends it urine to test. Second red flag. So, that’s what the doctor does. It doesn’t matter whether the urine needs to be tested or not. At least not to the doctor who just needs to test urine samples, or at the very least, bill Medicare, Medicaid, and TRICARE for the number of samples tested.
Unfortunately, for the doctor, the United States cares. The United States is paying. And it will not pay for urine tests that are not “reasonable and necessary for the diagnosis or treatment of an illness or injury.” Third red flag.
Doctor can’t show any illness or injury, except to his own finances.
After a couple whistleblowers exposed the fraudulent scheme and filed a qui tam action, doctor has to pay $1.8 million.
$343,500 to the whistleblowers. Not bad for doing justice.
Here’s the settlement agreement for your reading pleasure.
United States ex rel. Nuessner, et al. v. Austin Pain Associates, LLC, et al., 5:16-CV-1125-FB (W.D. Tex.)