NASHVILLE, TN — An Antioch medical clinic has agreed to pay $312,000 to resolve allegations by federal and state authorities that it submitted false claims to Medicare and Medicaid for “medically unnecessary” drug tests, according to the U.S. Attorney’s Office in Nashville.
The settlement also resolves allegations that the medical clinic, Pain Management Group P.C. (PMG), billed Medicare and Medicaid for the use of Botox and other medications not approved by the U.S. Food and Drug Administration.
In announcing the settlement Monday, the U.S. Attorney’s Office said the “claims settled by this agreement are allegations only, and there has been no determination of liability” on the part of PMG.
Medicare is the federal health care insurance program that covers people 65 and over, and the disabled. Medicaid is a federal-state program that helps pay for health care for the needy, aged, blind and disabled, and for low-income families with children.
The alleged violations by PMG occurred in 2014 and 2015, the federal prosecutors said. The U.S. Department of Health and Human Services and the Tennessee Bureau of Investigation began a probe of PMG after a data analysis spotted irregularities in the Antioch clinic’s administration of urine drug tests for patients on Medicare and TennCare, the state’s Medicaid program. (For more updates on this story and free news alerts for your neighborhood, sign up for your local Middle Tennessee Patch morning newsletter.)
The investigators also found that PMG administered non-FDA-approved medications to Medicare and TennCare patients and then billed the two programs for the drugs, prosecutors said. PMG bought the medications, which included Botox, Supartz and Eufflexa, from foreign-based suppliers.
Once PMG was informed of the federal and state investigation, the clinic’s doctors “cooperated and instituted remedial measures” to address the allegations, the U.S. Attorney’s Office said.