Pain Clinics’ Doctors Needlessly Tested Hundreds Of Urine Samples, Court Records Show

A Tennessee-based chain of pain clinics that abruptly turn off last summer faces five whistleblower lawsuits accusing it of defrauding Medicare and other health insurers by billing for countless unnecessary urine drug tests along with other dubious health services, newly unsealed court records show.

The federal suits target Tennessee-based Comprehensive Pain Specialists, also known as Anesthesia Services Associates, PLLC, and many of their physician owners. At its peak, CPS ran 60 pain clinics in 12 states, according to the suits, as well as a lucrative urine-testing lab in Brentwood, Tenn. CPS closed with no warning in July, leaving patients in several states distressed and scrambling to find a new supply of narcotic pain medicines.

In federal court filings unsealed in Nashville this week, federal prosecutors said they would dominate the urine-testing allegations and sue several CPS owners, including co-founding anesthesiologists Peter Kroll and Steven Dickerson. Dickerson is really a Republican state senator representing Nashville.

Kroll couldn't be reached for comment Wednesday. Dickerson didn't react to an email or a phone message left at his legislative office.

It is not clear whether the whistleblowers, who include former CPS doctors along with other employees, would pursue several allegations from the company the federal government declined to join in. CPS, in an unrelated court filing in December, said the company had terminated all of its employees which debts “greatly exceed its assets.”

Once among the largest pain management groups in the Southeast, CPS crumbled amid financial woes that included nearly a dozen civil suits alleging unpaid debts, along with a criminal investigation that ensnared its former leader, John Davis. Davis, 41, was convicted this month in federal court in Nashville on healthcare fraud charges. He is to be sentenced later this season.

CPS was the topic of a November 2021 investigation by Kaiser Health News that scrutinized its Medicare billings for urine drug tests. Medicare paid the company a minimum of $11 million for urine screenings and related tests in 2021, when five of CPS' medical professionals stood among the nation's top such Medicare billers. One nurse practitioner working at a CPS clinic in Cleveland, Tenn., generated $1.A million in urine-test billings that year, based on Medicare records analyzed by KHN.

Kroll, who also served as CPS' medical director, said at the time that the tests were justified for patient safety and also to reduce chances the pills may be sold on the underground community. Kroll billed Medicare $1.8 million for urine tests in 2021, the KHN analysis of Medicare billing records found.

Kroll in an interview with KHN at that time asserted he and fellow anesthesiologist Dickerson developed the idea for the pain clinics on the mug of coffee at a Nashville Starbucks in 2005.

One of the whistleblower suits alleging unnecessary urine tests was initially filed under seal in 2021 by Suzanne Alt, a doctor who worked within the company's pain clinics in Troy, Mo., and Keokuk, Iowa, from May 2021 to March 2021. She alleged CPS doctors were “strongly asked to order full-panel urine drug screens on each patient, every time, regardless of the patient's history, compliance and risk.”

She also asserted the business's electronic medical records “made it extremely hard to order anything under the full panel.” Alt said she was told the Tennessee lab did about 600 of those screens daily. Another whistleblower said he toured the lab with CPS executives and observed an “overpowering and unpleasant smell of urine.” In reaction, a CPS executive said, “To me, it smells like money,” based on the suit.

“They were making a killing,” said Birmingham, Ala., attorney Don McKenna, who represents Alt in the event.

Another of the whistleblowers, former CPS anesthesiologist Cynthia Niendorff, alleged that the company billed Medicare about $754 for every additional urine test, despite the fact that earlier results had return negative. She said CPS grossed approximately $6 million per month from the urine-testing lab and said about 20% of this amount was suspect, based on the suit.

Mary Butner, a former insurance specialist for CPS in Gallatin, Tenn., alleged that CPS charged some patients $1,500 for a drug test to measure blood levels of medication and $400 for any drug test designed to detect illegal drugs – charges the suit called “grossly inflated and disproportional to the actual costs.” She also alleged that CPS would fill prescriptions for patients whose drug tests detected the existence of illegal drugs, or demonstrated that they were not taking their medication as directed.

Butner also accused medical director Kroll of approving prescriptions for back braces if this was “clearly medically unnecessary,” including some people who had injuries to a knee or elbow.