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Tennessee Chiropractor Charged with Medicare Fraud
A federal lawsuit has been filed against Matthew Anderson, a chiropractor from Lenoir City, Tennessee, and David Florence, a doctor of osteopathy from Manchester, Tennessee, for making fraudulent claims to Medicare and TennCare. The lawsuit, filed in U.S. District Court in Nashville, alleges that Anderson and Florence made false claims in violation of the False Claims Act and the Tennessee Medicaid False Claims Act.
According to the complaint, Anderson operated four pain clinics in Tennessee, including Cookeville Center for Pain Management; Preferred Pain Center of Grundy County; McMinnville Pain Relief Center; and PMC Management. Although several of these clinics changed names at times, they were recently known as Cookeville Center for Pain Management; Spinal Pain Solutions in Harriman, Tenn; Preferred Pain Center of Grundy County in Gruetli Laager, Tenn; and McMinnville Pain Relief Center. Anderson operated these clinics both on his own and later through his management company, PMC Management.
The complaint alleges that Anderson believed that medical clinics had to have a physician owner, so he recruited several physicians to serve as the sham owners of the four pain clinics, while Anderson, and later his company PMC, managed the clinics. In fact, according to the complaint, Anderson was the true owner who controlled the pain clinics during the entire time they were in operation.
The complaint alleges that the four pain clinics engaged in the following fraud schemes: Anderson operated Cookeville Center for Pain Management as a pill mill in which a nurse practitioner wrote prescriptions for controlled substances for Medicare and TennCare patients that had no legitimate medical purpose. Medicare and TennCare ultimately paid for those prescriptions, which were not allowable under Program rules.
Anderson instructed employees at the four pain clinics to upcode office visits, by assigning an inaccurate billing code to increase Medicare reimbursement. Anderson continued to allow the pain clinics in Cookeville and Harriman to operate as pain management clinics and bill Medicare for services during a period in 2012 in which medical directors were not on site for the minimum time during operating hours as required by Tennessee law governing pain management clinics.
According to the complaint, Anderson reaped over $5 million from the four pain clinics, and took over 90% of the pain clinics’ profits, while the sham physicians only earned a salary for their service as medical directors. The government alleges that the scheme defrauded Medicare and TennCare of at least $1 million. The United States and Tennessee are seeking to recover treble damages plus penalties pursuant to the False Claims Act.
Matthew Anderson, a chiropractor from Lenoir City, Tennessee, and David Florence, a doctor of osteopathy from Manchester, Tennessee, have been charged with making fraudulent claims to Medicare and TennCare. The lawsuit was filed in U.S. District Court in Nashville on 05/23/2024. The exact outcome of the case is still pending.
Defendant:
Matthew Anderson, a chiropractor from Lenoir City, Tennessee
Criminal Charges:
Making false claims to Medicare and TennCare in violation of the False Claims Act and the Tennessee Medicaid False Claims Act
City and State:
Lenoir City, Tennessee
Exact Date:
05/23/2024
Sentence or Outcome:
Pending
Dollar Amounts:
$5 million (over) and $1 million (defrauded)
Key Facts
- State: Tennessee
- Category: Fraud & Financial Crimes
- Source: DOJ Press Release â†â€â€
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