Settlement Reached in Advanced Pain Care Billing Allegations

Dr. Mark Malone, founder of Advanced Pain Care, and his medical practice have agreed to pay over $13.6 million to settle allegations of improper billing related to urine drug testing. This settlement, announced by federal prosecutors, addresses claims that from 2017 to 2021, Malone and Advanced Pain Care submitted false claims to Medicare, Medicaid, TRICARE, and other government health programs for drug tests that were not medically necessary. The settlement will primarily benefit the federal government, with Texas receiving approximately $34,000.

Austin American-Statesman

The allegations against Advanced Pain Care include billing for both preliminary and advanced drug tests on the same patients and dates of service without reviewing initial results to justify further testing. Additionally, the practice reportedly used multiple billing codes for individual drug analytes when billing the Department of Veterans Affairs, which inflated reimbursements. As part of the settlement, Advanced Pain Care has entered into a five-year corporate integrity agreement with the U.S. Department of Health and Human Services Office of Inspector General. This agreement mandates the practice to enhance compliance oversight, conduct risk assessments, and engage an independent organization to review billing claims.

Austin American-Statesman

U.S. Attorney Justin Simmons stated, “Some, like Dr. Malone, instead cause harm by submitting false claims for procedures, thereby enriching themselves to the detriment of the American taxpayer.” He emphasized the commitment of his office to protect healthcare programs relied upon by the American public. It is important to note that the settlement resolves allegations raised in five lawsuits, and officials have clarified that these claims are allegations only, with no determination of liability made.

Austin American-Statesman

While the settlement addresses serious allegations, critics may argue that the financial penalties do not adequately reflect the potential harm caused to patients and the healthcare system. The implications of such billing practices can undermine trust in medical professionals and the integrity of healthcare programs.

Austin American-Statesman

Moving forward, Advanced Pain Care will be required to adhere to the terms of the corporate integrity agreement, which aims to prevent future violations and ensure compliance with federal healthcare regulations. The ongoing monitoring and assessment of their billing practices will be crucial in restoring confidence among patients and the healthcare community.

Austin American-Statesman