CLARKSVILLE, TN (CLARKSVILLE NOW) – A federal judge has called the allegations of fraud against the owners of a Clarksville and Nashville pain clinic to be “sparse” and “vague and conclusory” in dismissing the case against them.

Several months ago, the U.S. Attorney’s Office released a statement that Debbie and Michael Cox, owners of Pain Institute of Nashville (PIN) and Clarksville Pain Institute (CPI), were being sued due to allegations of billing fraud and false claims.

On March 6, the federal judge granted the Coxes’ motion to dismiss due to lack of direct evidence of their involvement. The claims against the CPI and PIN clinics were also dismissed.

Former employee files suit

On April 10, 2020, Krista Nicholson, a former CPI employee, filed a “qui tam” complaint, which is a provision under the False Claims Act that allows whistleblowers to sue on behalf of the government for fraud against the government. If the lawsuit is successful, the whistleblower can receive a portion of the recovered funds as a reward.

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According to court documents, the Pain Institute engaged in false billing claims and fraud schemes to defraud millions from the Federal Health Benefits Program from 2014-2024.

The government alleges the Coxes did this by billing false claims through “unnecessary medical testing” schemes on patients: Urine Drug Testing (UDT), allergy testing, reflex testing and psychological testing.

‘No evidence’

In the court’s opinion, Debbie Cox’s involvement was “sparse.” The government alleged that both defendants issued blanket and standing orders over the years in “various ways” of communication (text, verbal, email, etc.) but the judge noted that these communications are not described.

In one such example, Debbie disseminated a new policy that required patients to be furnished with Narcan, and she informed clinic employees that Narcan would be “mandatory just like a drug screen.” But the judge disagreed that this text was sufficient in proving the UDT standing/blanket order scheme.

“At most, this text can be plausibly construed to mean that patient receiving long-term opioid treatment must undergo drug screens in certain situations,” the court documents stated. “In short, the text message does not confirm or even imply the existence of the UDT schemes alleged in this lawsuit.”

Additionally, there was “no evidence that she treated any of the specific patients who were presented for false claims, that she submitted those claims, played any role in the submission of the claims, or that she even knew about them.”

‘Vague’ and ‘conclusory’

“The claims against Michael Cox fare little better, as the allegations involving him are no less vague and conclusory,” the judge stated. According to the complaint, Michael was alleged to have “pressured providers by telling them things like ‘It’s your license,’ and ‘It’s on you if you don’t order a drug screen.'”

According to the court opinion, not only do these alleged statements not meet Rule 9(b), which requires a higher level of detail when alleging fraud, but that they are also “inescapably true.” “Providers have responsibility for ordering medically necessary testing, and their failure to do so results in certain outcomes that could jeopardize their licensure,” the judge stated.

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According to court documents, on Sept. 1, 2015, Michael exchanged emails with another clinic employee regarding the medical necessity of UDT for “Patient A,” which Michael appeared to approve. On March 10, 2016, a progress report from Patient A included identical language to the email exchange. The government alleged that this was evidence that the clinic providers were copying and pasting patient notes and was proof of Michael’s involvement in a fraud scheme.

“To conclude from that single email that Michael Cox personally devised a scheme to bill medically unnecessary services, communicated that scheme to providers, and incentivized them to follow it requires many inferential leaps,” the judge stated.

Dismissals

The court dismissed the claims against the Coxes individually, saying the complaint did not provide enough specific evidence. The claims against the clinics were also dismissed.

Clarksville Now has reached out to the Coxes and their attorney, Matthew Curley, for comment.

Correction: The claims against the clinics were dismissed as well. The article has been updated. 

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