CODING

Tennessee Pain Doctor Faces Jail for Opioid Abuses, Medicare Fraud

Case: The doctor is facing 45 charges, including 22 counts of illegal distribution of a controlled substance for routinely prescribing oxycodone and other Schedule II drugs without examining and diagnosing patients, including one Chronic Pain Syndrome patient who died as a result of ingesting “The Holy Trinity” of oxymorphone, Soma and alprazolam. According to the indictment, the doctor required Medicare beneficiaries to visit his office four to six times per month for the same services cash-paying patients only had to come in twice a month to receive. He also allegedly wrote 164 individual prescriptions for over 12,000 Schedule II controlled substance pills the very day the State of Tennessee permanently revoked his Pain Management Certificate.

Significance: As is commonly the pattern in these opioid distribution scams, the doctor allegedly exacerbated his wrongdoings by engaging in Medicare fraud (13 counts) and money laundering (9 counts), including:

  • Upcoding claims to indicate a higher level of service than actually provided;
  • Billing for services that weren’t medically necessary;
  • Causing submission of claims for unlawful prescriptions to Medicare; and
  • Diverting proceeds of the fraud.
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