NASHVILLE, Tennessee – Two companies that ran a Clarksville pain management clinic and two of their managers have agreed to pay $1.5 million to settle federal claims that they billed Medicare and the Department of Veterans Affairs for medically unnecessary tests, U.S. Attorney Braden H. Boucek of the Middle District of Tennessee announced.
The settlement resolves False Claims Act allegations against Clarksville Pain Institute, LLC; Pain Institute of Nashville, PLC; Michael Cox; and Debbie Cox. The claims are allegations only, and there has been no determination of liability.
What the government alleged
The United States filed a complaint on September 11, 2024. It accused the defendants of submitting, or causing others to submit, false claims to Medicare and the VA between April 2014 and May 2024.
The complaint centered on three types of testing: urine drug testing, allergy testing and psychological testing. Prosecutors said the tests were not medically necessary.
The clinic
Clarksville Pain Institute operated a pain management clinic with its main location in Clarksville. It also had locations in White House and Springfield. The clinic merged with Pain Institute of Nashville in 2018.
Michael Cox and Debbie Cox held various management positions with both entities. Debbie Cox also held an ownership interest in both.
Settlement terms and whistleblower
Under the settlement, the defendants will collectively pay $1.5 million to the United States.
The agreement also resolves a whistleblower lawsuit filed by Krista Nicholson, a former employee, under the qui tam provisions of the False Claims Act. Those provisions let private individuals sue on behalf of the United States and share in any money recovered. Nicholson will receive $285,000.
Boucek said federal health care programs exist to pay for necessary care.
“Federal health care programs exist to provide necessary medical care, not to generate payments for unnecessary testing,” said U.S. Attorney Boucek. “When providers allegedly misuse these programs for financial gain, they undermine public trust and divert taxpayer dollars from legitimate patient care. Our office will continue working with our federal partners to protect the integrity of these programs and hold those who submit false claims accountable.”
Investigation
The U.S. Attorney’s Office for the Middle District of Tennessee, the Department of Health and Human Services Office of Inspector General and the Department of Veterans Affairs Office of Inspector General investigated the case. Assistant U.S. Attorney Wynn M. Shuford represented the United States.
The civil case is captioned United States ex rel. Nicholson v. Clarksville Pain Institute, et al., Case No. 3:20-cv-00309 in the Middle District of Tennessee.
