Preferred Pain Management & Spine Care, P.A. (PPM) and its owner, Dr. David Spivey, have agreed to pay $789,292.95 to resolve civil allegations that PPM violated the False Claims Act by billing Medicare, Medicaid, and other federal healthcare programs for medically unnecessary urine drug testing (UDT) between June 1, 2014 and May 24, 2017. The United States alleged that PPM knowingly submitted or caused the submission of false claims to federal healthcare programs for presumptive and definitive UDT, in circumstances where such testing was not medically reasonable or necessary. Presumptive UDT are tests that screen for the presence of drugs, and definitive UDT are tests that identify the concentration of those drugs in a patient’s system. The government alleged that PPM and Spivey automatically ordered both presumptive and definitive UDT for all patients at their monthly visits, without conducting individualized determinations of need or risk profile. The United States further contended that PPM billed Medicare for specimen validity testing, a quality control process used to analyze a urine specimen to ensure that it has not been diluted or adulterated. Since January 2014, Medicare’s guidance has been explicit that specimen validity testing should not be separately billed to Medicare. The United States asserted that PPM nonetheless submitted claims to Medicare for specimen validity testing throughout 2014 and 2015.
