CleanSlate / Total Wellness Centers: Prescriptions First, Physician Review Later

The CleanSlate / Total Wellness Centers fraud case ended in a $750,000 civil settlement over allegations of backdated buprenorphine prescriptions and Medicare visits billed at physician rates without a physician on site. The government described a gap that clinic staff would recognize: a physician’s name on the prescription or claim, with the physician’s actual involvement somewhere else in the sequence. The government alleged that patients had already picked up their medication before a doctor reviewed their visit.

CleanSlate Centers Inc. and Total Wellness Centers LLC, doing business as CleanSlate, operated opioid addiction treatment centers in Massachusetts and other states. At the time of the settlement announcement, CleanSlate operated 17 clinics offering medication and counseling. Buprenorphine, identified in the release by the brand Suboxone, was the medication at the center of the prescribing allegations. The release describes it as a Schedule III controlled substance used to treat addiction to opioids, including heroin and prescription painkillers.

Prescriptions Signed After Patients Had Their Medication

The government alleged that CleanSlate clinics represented prescriptions as physician-issued before a physician had reviewed the patient visit. From March 2012 through February 2014, clinics allegedly contacted pharmacies saying physicians had prescribed buprenorphine, although only midlevel practitioners had seen the patients.

The government described the alleged sequence: patients obtained the medication, then days later part-time physicians accessed the electronic medical records and reviewed the visit information. The doctors then allegedly signed the prescriptions and backdated them to the visit dates. The release says some of those physicians worked for CleanSlate for as little as six hours per month.

In that alleged sequence, we see a doctor’s signature being asked to do something impossible: turn a later review into an earlier prescribing decision.

A prescription bearing the visit date would hide that sequence if read without the underlying history. Someone who handled pharmacy calls or physician chart review could recognize what the finished prescription left out.

Physician-Rate Claims Without a Physician on Site

The Medicare billing allegation concerned who treated the patient and who was present to supervise. From June 2010 through April 2016, the government alleged, CleanSlate repeatedly billed visits using physicians’ identification numbers even though midlevel practitioners saw the patients and no physicians were on the clinic premises.

That billing choice affected the payment. The Justice Department said Medicare would have paid less had CleanSlate billed under the midlevel practitioners’ own identification numbers. Taxpayers bore the alleged excess payment.

Reviewing a chart later and being present during a visit are different events. The prescribing allegation concerned the timing of authorization. The visit-billing allegation concerned the physician’s absence during care. The same doctor’s name could obscure that difference on paper.

What the Civil Settlement Changed

The U.S. Attorney’s Office for the District of Massachusetts reached the agreement on November 21, 2016 and announced it the following day. The agreement resolved both sets of allegations together: prescribing under the Controlled Substances Act and Medicare billing under the False Claims Act.

The announcement reported that CleanSlate had begun hiring at least one full-time physician for each clinic. That staffing response addressed the physician-presence issue at the center of the Medicare allegations.

The prescribing change addressed the order of events directly. According to the announcement, CleanSlate implemented an electronic system in which only doctors could prescribe buprenorphine and no prescription could issue until a doctor had reviewed the visit information. The control addressed exactly what the government said the earlier process had reversed.

Why the Treatment Dates Matter

The release explains that only physicians could prescribe buprenorphine for addiction treatment before Congress changed the law in July 2016. That change allowed nurse practitioners and physician assistants to prescribe it subject to training and state licensing requirements.

The Same Physician-Billing Gap in Another Practice

In the separate Texas Behavioral Health and United Psychiatry Institute case, the government also alleged that nonphysician mental health services were billed at physician rates without the required physician involvement or supervision.

What Evidence Is Needed to Prove Fraud?

For a prescribing or physician-billing case, the useful evidence connects the patient visit with what the pharmacy or Medicare was told. We look at the treating professional, the prescription and review dates, the physician’s presence and the billing identity used for that encounter.

Someone working in scheduling may know which clinicians were present. Someone reviewing charts may know when physician approval actually occurred. Someone in billing may know whose identification number went onto the claim. We work with the insider to connect those parts of the same visit, including who directed the process. That is where knowledge of an ordinary clinic workflow can give a health care fraud case its substance.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know When the Doctor Was Involved

If you handled pharmacy calls, reviewed charts or saw whose name went onto Medicare claims, tell our whistleblower experts how the clinic actually worked. We develop the case with you and bring in healthcare fraud whistleblower lawyers who understand addiction treatment, prescribing records and physician billing. We stay beside you as your account of the clinic becomes a case built around what happened and who directed it.