Comprehensive Pain Specialists: Standing-Order Testing and Owners’ Billing Exposure

In the Comprehensive Pain Specialists fraud settlement, the company, four majority owners and a former executive agreed to pay $4,121,663 to resolve allegations of unnecessary testing, nonreimbursable acupuncture and false physician billing. The alleged testing system reached into the clinic before a clinician assessed the patient: standing orders, mandatory specimens and a company laboratory waiting for the work. For someone who saw those instructions become Medicare or TennCare claims, the case shows how decisions inside a pain practice can reach both the company and the people running it.

Anesthesia Services Associates operated as Comprehensive Pain Specialists, based in Brentwood, Tennessee. The Justice Department’s April 21, 2021 announcement described more than 40 pain clinics and operations in twelve states before CPS closed in 2018. Whistleblowers brought the qui tam cases, and the United States and Tennessee joined the testing and billing allegations.

Standing Orders Fed the Company’s Laboratory

CPS’s own laboratory made the alleged standing-order policy more lucrative: the government described a reimbursement rate nearly five times the rate for on-site testing. According to the government’s complaint announcement, CPS began operating its Franklin, Tennessee laboratory in July 2012 and required providers to send all urine specimens and blood work there.

The government alleged that CPS automatically ordered quantitative drug testing, specimen-validity testing, genetic blood testing and psychological testing on virtually all patients, without regard to individual risk or need. A practice-wide instruction could therefore determine both how much testing a patient received and which business collected the laboratory revenue.

The whistleblower’s amended complaint describes the distinction between a qualitative screen, which detects drugs, and quantitative testing, which measures their concentrations. It alleged that CPS ordered both together before the first result could inform the next decision.

That connection between the specimen and the next bill appears elsewhere in the industry. The 2020 Journal of Forensic and Investigative Accounting paper A Forensic Accountant’s Guide to the Most Potent Federal Laws Used Against Healthcare Fraud discusses Millennium Health’s settlement of allegations that it supplied free urine-testing cups on condition that doctors return specimens for additional costly tests. We see the same incentive in both accounts: control where the specimen goes, and more testing becomes more laboratory revenue.

Tests Ordered Before Clinical Review

The whistleblower’s first amended complaint alleged that non-clinical staff started the testing process before trained medical staff could assess whether it was needed. Its account places the decision in the clinic’s routine workflow:

The complaint also alleged that patients could not obtain a prescription until they provided a urine specimen. Staff selected testing panels in the electronic health record, and the whistleblower understood those selections to send orders for both qualitative and quantitative testing to CPS’s laboratories. The order was already moving while the clinical question was still waiting.

This pattern also appeared in Physician Partners of America, where the government alleged testing mandates before physician examination and compensation tied to 40% of presumptive-testing profits. That separate settlement involved unnecessary urine, genetic and psychological testing allegations. The connection is the financial pull on the order: what the practice required, what the clinician decided and who benefited from the test.

Results Waited While Testing Continued

The whistleblower alleged that CPS kept ordering urine screens even when staff had not used earlier results to manage the patient’s care. One Medicare patient at the Alton, Illinois clinic received six screens within ten months despite no non-compliant results. The complaint described what happened to one result:

We find the contrast hard to miss: the alleged system insisted on getting the specimen, then left the result unread. The patient supplied what the laboratory needed to bill, while the information supposedly needed for treatment waited.

The same complaint alleged that medical assistants marked psychological test results as reviewed even though they typically did not review them or know how to interpret them. It also alleged that CPS encouraged providers to copy templates into progress notes that overstated the complexity or level of services. The government’s complaint announcement separately alleged that the former CEO engaged in upcoding by altering providers’ claims to increase government reimbursement. For an insider, the difference between the chart and the work performed may explain why a claim looked supportable to someone who never entered the exam room.

A Physician on the Claim, Abroad During the Care

The government separately alleged that CPS submitted claims under a physician owner’s provider number for services he did not render and tests he did not order. In one example, it alleged more than 2,500 Medicare claims for procedures and testing during a period when the physician was abroad on vacation, with almost $350,000 paid to CPS. The Justice Department said Medicare revoked that owner’s billing privileges as a result.

The provider number connected the bill to a particular physician, while the allegation concerned what he actually did. That is why whose work appears under a physician’s number belongs beside the appointment record, the test order and the treatment note. A clinician may know who saw the patient, while a billing employee knows whose identity went onto the claim.

The Acupuncture Overpayment Management Allegedly Kept

The government alleged that CPS’s former CEO knew the practice had received more than $130,000 for nonreimbursable acupuncture and decided not to refund Medicare. The allegation included services rendered by physician owners, placing both the treatment and the later payment decision inside the practice.

That makes the acupuncture branch a useful example of an identified overpayment left unreturned. Someone who saw the reimbursement problem reach management may know a different part of the case from the employee who submitted the original bill. The settlement later covered electro-auricular acupuncture along with the testing allegations.

What the Company and Owners Agreed to Pay

The April agreements divided the obligations among CPS, its owners and a former executive. CPS agreed to release $2,196,663 already held in a Medicare suspension account and contribute another $750,000 in cash. The owners collectively agreed to pay $1.05 million. The former executive, a chiropractor who had managed East Tennessee clinics, agreed to pay $125,000 to resolve the government’s separate claims against him.

The agreements covered alleged testing and acupuncture claims from May 2011 through CPS’s closure. The government had alleged at least $25 million in losses to Medicare and TennCare. The alleged loss to public health care dwarfed the agreed settlement. The obligations still reached the owners after the clinics closed.

The Former CEO’s Remaining Civil Case

The Justice Department announced his separate civil resolution on August 3, 2021, resolving the remaining allegations of unnecessary or nonreimbursable testing and acupuncture. The earlier complaint tied the alleged testing policies and the acupuncture refund decision to his management role. His resolution followed the company and owner agreements, which had left those claims open.

What Evidence Does a Whistleblower Need?

For allegations like these, the useful evidence connects the testing instruction to the patient’s care and the government claim. An ordering screen can show how the test entered the system, a result and review date can show what happened afterward, and a progress note can be compared with the service actually performed. The billing record then shows what the practice asked Medicare or TennCare to pay.

Whistleblower lawsuits prompted the CPS investigation by the Department of Health and Human Services Office of Inspector General and the Tennessee Bureau of Investigation Medicaid Fraud Control Unit. The insiders’ accounts gave investigators something to examine beyond the face of a bill. We help clinic insiders turn that knowledge and those records into a case with whistleblower lawyers who know physician billing fraud.

How Much of a Settlement Does a Whistleblower Get?

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. The CPS announcement provided a collective share of the settlement proceeds for the whistleblowers who brought the cases.

You Saw How the Orders Became Bills

If your clinic’s testing orders arrived before the clinical decision, or its claims named a physician who did not do the work, talk with our whistleblower experts about what you saw. We build the case with you and bring in physician billing fraud whistleblower lawyers who understand laboratory orders, clinical records and payment decisions. You get partners who stay beside you through the case and understand why the details inside the practice matter.