National Spine and Pain Snared in Anti-Kickback/Fraud Investigation

[drusso]

Does anyone know any backstory on this?

National Spine & Pain Center to pay $5.1M billing fraud settlement: 5 details

Laura Dyrda - 2 hours ago Print | Email
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A Rockville, Md.-based spine and pain center chain will pay millions to resolve Medicare fraud claims.



Five details:

1. National Spine & Pain Center admitted to contracting with Proove Biosciences, a defunct genetics testing company, to pay physicians for referrals disguised as compensation for a clinical research program.

2. Proove allegedly paid National Spine & Pain Center physicians per test and per patient to complete timesheets saying they spent more time than they did with patients on clinical research. Some physicians also said they performed tasks on the timesheets when Proove employees completed the tasks.

3. National Spine & Pain Centers said its team told Proove it would not provide genetic testing unless the company stayed current on payments, and Proove set expectations for the physicians to order a certain number of tests.

4. Physical Medicine Associates, a physician group associated with National Spine & Pain Center, received $1.1 million from Proove, and Medicare paid Proove $4 million for the fraudulent claims.

5. National Spine & Pain Center agreed to pay $5.1 million in restitution to settle allegations that its agreement with Proove violated the Anti-Kickback Statute.

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[Agast]

Is that the giant East coast clinic with KOLs

 

[drusso]

Is that the giant East coast clinic with KOLs

How many KOLs were caught in the drag net?

 

[Multimodal]

I almost joined this group.....glad I didnt. I felt like they kept telling me what I wanted to hear during the interview.

 

[bedrock]

I almost joined this group.....glad I didnt. I felt like they kept telling me what I wanted to hear during the interview.

They were slimy. They invited me for an interview, though they wouldn't pay for my transportation, which I took as a bad sign as a graduating fellow. Glad I stayed away.

Everything I've heard since then about the group has not suggested their ethics are anything but appropriate.

 

[jsaul]

Isn't this group run by private equity?

 

[gaseous_clay]

Isn't this group run by private equity?

Yes, they are the largest interventional pain practice in the US / world and they are backed by more than one PE group.

 

[gaseous_clay]

This isn’t the first time they have paid out multimillion dollar fines to CMS. What I don’t get is how their compliance attorneys would sign off on these types of illegal schemes.

 

[afob100]

Drop in the bucket for them

 

[ateria radicularis magna]

This isn’t the first time they have paid out multimillion dollar fines to CMS. What I don’t get is how their compliance attorneys would sign off on these types of illegal schemes.

Yeah, how is this possible?

 

[lobelsteve]

This isn’t the first time they have paid out multimillion dollar fines to CMS. What I don’t get is how their compliance attorneys would sign off on these types of illegal schemes.

Paid for opinion without risk to themselves.

 

[gaseous_clay]

Paid for opinion without risk to themselves.

They should follow the attorneys’ advice. This is similar to the Insys scandal.

 

[nvrsumr]

the rest of us would get jail time for Medicare fraud

 

[DrSpine]

I don't understand how these groups and hospital systems continually get busted for fraud and just pay a fine. Meanwhile a PP guy gets busted and he's in prison for years with license revoked.

 

[SSdoc33]

I don't understand how these groups and hospital systems continually get busted for fraud and just pay a fine. Meanwhile a PP guy gets busted and he's in prison for years with license revoked.

you seem to be under the illusion that the justice department is fair.

money talks

there are reasons that orange former presidents aren't in jail (couldn't resist)

 

[bedrock]

you seem to be under the illusion that the justice department is fair.

money talks

there are reasons that orange former presidents aren't in jail (couldn't resist)

Have to agree with you on both counts

 

[ateria radicularis magna]

They should follow the attorneys’ advice. This is similar to the Insys scandal.

But really, all snarky comments aside, how is is possible to make such a big mistake/decision?

 

[Agast]

But really, all snarky comments aside, how is is possible to make such a big mistake/decision?

Never involve Medicare in your schemes. Bunch of n00bs

 

[gaseous_clay]

But really, all snarky comments aside, how is is possible to make such a big mistake/decision?

Nothing snarky about my comment. All these big PE backed groups hire large compliance firms that typically scrutinize these types of arrangements. I don’t see how their attorneys missed this or why they wouldn’t follow legal advice.

 

[buddababa]

probably because the money made - the expected fines/fees = profit. I'm sure they did the math.

 

[ateria radicularis magna]

probably because the money made - the expected fines/fees = profit. I'm sure they did the math.

What kind of money can be made by this kind of arrangement? Millions of dollars seems like a big number from my naive perspective

 

[ateria radicularis magna]

If your group is subject to this kind of investigation and fine, how does that shake out? Who actually pays if it is the “group” that is found liable? How does this effect the licenses of the doctors in the group? How does it effect the group’s standing among peers in their communities? How can you recruit new doctors after this?

 

[SSdoc33]

If your group is subject to this kind of investigation and fine, how does that shake out? Who actually pays if it is the “group” that is found liable? How does this effect the licenses of the doctors in the group? How does it effect the group’s standing among peers in their communities? How can you recruit new doctors after this?

the "group" pays. owners are ultimately liable, but that will trickle down. standing among peers? i really think this won't change a thing re: referral patterns or new doc hires. this is a mill and they will hire a new grad who probably won't even read the press release

 

[buddababa]

A similar midwest organization based out of Milwaukee was essentially shut down and doctors had to fend for themselves; its only a matter of time.

 

[ateria radicularis magna]

A similar midwest organization based out of Milwaukee was essentially shut down and doctors had to fend for themselves; its only a matter of time.

What does “fend for themselves” entail? Hire lawyers? Leave their profession?

 

[Agast]

A similar midwest organization based out of Milwaukee was essentially shut down and doctors had to fend for themselves; its only a matter of time.

Talking about this group?

 

[NJPAIN]

probably because the money made - the expected fines/fees = profit. I'm sure they did the math.

Exactly. I recall the days when “blue laws” existed forbidding stores to be open for business on Sunday. The penalty was a fine and possible jail time. A local large discount store would open EVERY Sunday. Every Sunday a large fine was assessed but no jail to the owner. Every week profit to the store open on Sunday>>>fine. Never any jail time because then the city would lose the fine. Same game on a smaller scale…

 

[cowboydoc]

Exactly. I recall the days when “blue laws” existed forbidding stores to be open for business on Sunday. The penalty was a fine and possible jail time. A local large discount store would open EVERY Sunday. Every Sunday a large fine was assessed but no jail to the owner. Every week profit to the store open on Sunday>>>fine. Never any jail time because then the city would lose the fine. Same game on a smaller scale…

Are you really old or referring to a liquor store?

 

[buddababa]

Talking about this group?

Yup. That's the one.

 

[NJPAIN]

Are you really old or referring to a liquor store?

I guess I’m pretty old compared to most of you guys./gals. It wasn’t until around 1976 that blue laws were lifted and department stores in NY started to open on Sunday. Small retailers followed soon after. The days when stores closed at 6pm and we purchased toys in toy stores (not ToysRUs or Amazon) and office supplies in a stationary store or office supply store rather than Staples. So ends the history lesson for today.

 

[drusso]

I guess I’m pretty old compared to most of you guys./gals. It wasn’t until around 1976 that blue laws were lifted and department stores in NY started to open on Sunday. Small retailers followed soon after. The days when stores closed at 6pm and we purchased toys in toy stores (not ToysRUs or Amazon) and office supplies in a stationary store or office supply store rather than Staples. So ends the history lesson for today.

I remember all this plus going back to school shopping at Sears.

 

[gaseous_clay]

I guess I’m pretty old compared to most of you guys./gals. It wasn’t until around 1976 that blue laws were lifted and department stores in NY started to open on Sunday. Small retailers followed soon after. The days when stores closed at 6pm and we purchased toys in toy stores (not ToysRUs or Amazon) and office supplies in a stationary store or office supply store rather than Staples. So ends the history lesson for today.

Why did they call them blue laws?

 

[NJPAIN]

Why did they call them blue laws?

In the United States, “blue laws,” so called due to the blue paper on which Puritan leaders printed the Sunday trade restrictions, date back to the 18th century at least. Many forms of commerce were regulated or restricted so that workers should spend time in church or with their families.

The town of Paramus NJ is one of the few places that I know which still has a blue law. Not for religious reasons but rather because it is filled with shopping including several malls. Residents of the town feel that they need a day off from the traffic and craziness.

 

[Nodolor]

Today they would called "Red Laws"

 

[Dr. Ice]

In the United States, “blue laws,” so called due to the blue paper on which Puritan leaders printed the Sunday trade restrictions, date back to the 18th century at least. Many forms of commerce were regulated or restricted so that workers should spend time in church or with their families.

The town of Paramus NJ is one of the few places that I know which still has a blue law. Not for religious reasons but rather because it is filled with shopping including several malls. Residents of the town feel that they need a day off from the traffic and craziness.

I thought that applied to all of Bergen county. I grew up in Morris, we never had such blasphemy lol

 

[NJPAIN]

I thought that applied to all of Bergen county. I grew up in Morris, we never had such blasphemy lol

You can’t sell electronics, clothing or furniture in all of Bergen County. In Paramus specifically you can’t sell ANYTHING except groceries. It’s crazy, if you go into one of the many Asian markets, the aisles containing electronics like rice cookers are all roped off on Sunday.

 

[SSdoc33]

college in CT had blue laws. package store closed at 8 pm. WTF!?!?!?!

 

[Ducttape]

South Carolina still has sunday liquor laws, as far as i am aware.

when i lived down there, could only use mini bottles...

 

[NJPAIN]

South Carolina still has sunday liquor laws, as far as i am aware.

when i lived down there, could only use mini bottles...

Glad to see that you made it through that hardship

 

[joshmir]

It appears the reason there were fines, but no providers on the hot seat, was there was no prosecution of individuals. As far as I know, you dont' "prosecute" a "corporation" - someone with more legal knowledge correct me if im wrong


"The non-prosecution agreement cited NSPC’s new ownership group, its voluntary termination of its relationship with Proove prior to the company’s knowledge of the criminal investigation, its continuing cooperation with investigators, and the adoption of a robust compliance program, as factors that supported the resolution of the criminal investigation with a non-prosecution agreement."

from:

Pain Management Organization Pays $5.1 Million to Settle Criminal Medicare Kickback Violations

www.justice.gov

 

[pastafan]

At the beach in NC no beer sales allowed until noon on Sunday. There are always a bunch of guys circling the isles with carts around 11:30.

 

[Pain Applicant1]

Is that the giant East coast clinic with KOLs

Yes, I know them very well. Well-oiled business. Many NPs and PAs. Biggest pain mgmt group in the US I believe. One of the higher-ups is Meghan Kelly's ex. That's how they made it on her show one time. I know many pts are not happy with the way things are practiced. I know many of their docs are not happy either.

 

[drusso]

Yes, I know them very well. Well-oiled business. Many NPs and PAs. Biggest pain mgmt group in the US I believe. One of the higher-ups is Meghan Kelly's ex. That's how they made it on her show one time. I know many pts are not happy with the way things are practiced. I know many of their docs are not happy either.

What do you mean "not happy?"

 

[NJPAIN]

What do you mean "not happy?"

I’m interested to hear also but I assume on the Dr side of things it’s the typical if you’re near retirement and ready to take the cash and run after they buy your practice it’s great otherwise working for the corporate machine is grueling and demoralizing?

 

[Pain Applicant1]

What do you mean "not happy?"

For the pts as you can probably imagine they feel it's the typical conveyor belt medicine, not being paid attention to, etc. I imagine the docs have a lot of pressure to produce and see pts. Kind of more of a product than a person. Of course, I'm only seeing and hearing this from the pts who are not happy so this really wouldn't be objective. I'm sure there are many pts who are happy there and some (I hope not many) pts who complain about me to other doctors. This is first-hand info, btw.

FWIW, I also notice that they tend to prescribe higher doses of opioids than I do and to prescribe to pts who I would choose not to.

As for the doctors, I hear low starting pay and a high turnover rate. This is second-hand information from a few reps with who I've become friendly.

They offered to "buy" me out several years ago. Not really a buy but more of a join them where they pretty much swallow you up. Umm, F that.

 

[Pain Applicant1]

I’m interested to hear also but I assume on the Dr side of things it’s the typical if you’re near retirement and ready to take the cash and run after they buy your practice it’s great otherwise working for the corporate machine is grueling and demoralizing?

see above

 

[Dr. Ice]

The doc in jersey with that group will stim anything he gets his hands on

 

[Pain Applicant1]

In the United States, “blue laws,” so called due to the blue paper on which Puritan leaders printed the Sunday trade restrictions, date back to the 18th century at least. Many forms of commerce were regulated or restricted so that workers should spend time in church or with their families.

The town of Paramus NJ is one of the few places that I know which still has a blue law. Not for religious reasons but rather because it is filled with shopping including several malls. Residents of the town feel that they need a day off from the traffic and craziness.

My sister lives there and I can confirm the madness there. It's like strip malls on steroids. Living out in the country now, I really don't know how people can put up with this. I hope I'm the last man on the boat in my small town and I'm glad the guy before me wasn't.

 

[ateria radicularis magna]

For the pts as you can probably imagine they feel it's the typical conveyor belt medicine, not being paid attention to, etc. I imagine the docs have a lot of pressure to produce and see pts. Kind of more of a product than a person. Of course, I'm only seeing and hearing this from the pts who are not happy so this really wouldn't be objective. I'm sure there are many pts who are happy there and some (I hope not many) pts who complain about me to other doctors. This is first-hand info, btw.

FWIW, I also notice that they tend to prescribe higher doses of opioids than I do and to prescribe to pts who I would choose not to.

As for the doctors, I hear low starting pay and a high turnover rate. This is second-hand information from a few reps with who I've become friendly.

They offered to "buy" me out several years ago. Not really a buy but more of a join them where they pretty much swallow you up. Umm, F that.

What happens to those high turnover young docs? I assume they’ve signed some kind of horrific Franken-contract with a 25 mile non compete. This is the essence of private equity medicine with contract CEO. They are experts in things that have nothing to do with health.

 

[Ferrismonk]

What happens to those high turnover young docs? I assume they’ve signed some kind of horrific Franken-contract with a 25 mile non compete. This is the essence of private equity medicine with contract CEOs “with vast experience in healthcare.” They are experts in things that have nothing to do with health.

I used to work for a large and growing private-equity backed pain group. I thought my contract was "fair" at the time I signed, but once I learned more I realized it really was only "fair". Nothing technically wrong, but they pushed lots of DME, frequent UDS, and ASC procedures. I had a noncompete that was 15 miles from locations I worked. I left after a few years when I realized I couldn't grow with the company. Much happier now making more money doing less of the things that drove me nuts.