Now-defunct Austin Pain Associates physicians agree to pay $3.9m to resolve allegations relating to unnecessary tests, fraudulent billing

The settlements with Wills and Frank resolve allegations that the physicians, formerly co-owners of now-defunct Austin Pain Associates located in Austin, Texas, knowingly caused the submission of false claims to federal healthcare programs by ordering excessive and unnecessary urine drug testing for patients without any individualized assessment of clinical need.

Starting in 2011, all urine drug tests ordered by Austin Pain Associates’ physicians, including Wills and Frank, were performed at Austin Pain Associates’ in-house laboratory.

The United States alleged that Wills and Frank drafted the testing protocols that resulted in unnecessary tests, were aware that the in-house laboratory was conducting an excessive number of tests on urine samples, and that Austin Pain Associates could not remain profitable without the income generated from unnecessary testing.

Pursuant to their respective settlement agreements, Wills has agreed to pay $2,100,000 to settle these allegations and Frank has agreed to pay $1,800,000.

“The provision of medical services should be based on a patient’s medical needs, not on a physician’s desire to increase profits,” said Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division. “The Department of Justice is committed to taking appropriate action to safeguard the integrity of federal healthcare programs and the welfare of their beneficiaries.” 

“Physicians who bill taxpayer-funded health programs for expensive and medically unnecessary drug tests increase the cost of healthcare for all of us,” said U.S. Attorney Ashely C. Hoff for the Western District of Texas. “We will continue to vigorously investigate and prosecute allegations of false claims submitted to Medicare, Medicaid, TRICARE, and any other government health program.”

“Physicians who perform medically unnecessary and excessive tests exploit patients and taxpayer-funded healthcare programs,” said Special Agent in Charge Miranda Bennett for the Department of Health and Human Services Office of Inspector General (HHS OIG).  “With our law enforcement partners, we will continue to hold accountable individuals who engage in false claims practices.”

“Today’s outcome demonstrates the commitment of the Department of Defense Office of the Inspector General, Defense Criminal Investigative Service (DCIS), in coordination with our law enforcement partners to diligently investigate allegations of fraud committed against TRICARE,” said Special Agent in Charge Michael Mentavlos of the DCIS Southwest Field Office. “We will continue to hold accountable individuals who obtain taxpayer funds through false and fraudulent means.”

Medicaid is funded jointly by the states and the federal government. The State of Texas paid for a portion of the Medicaid claims at issue and will receive a total of approximately $260,000 from the settlements with Wills and Frank.        

The civil settlement includes the resolution of claims brought under the qui tam or whistleblower provisions of the False Claims Act by Jennifer Nuessner and Robert Hoffman, former employees of Austin Pain Associates.

Under those provisions, a private party can file an action on behalf of the United States and receive a portion of any recovery.

As part of the resolutions with Frank and Wills, the two whistleblowers will receive a total of approximately $618,000 from the federal share of the settlements. The qui tam case is captioned United States ex rel. Nuessner, et al. v. Austin Pain Associates, LLC, et al., 5:16-CV-1125-FB (W.D. Tex.). 

The resolutions obtained in this matter were the result of a coordinated effort among the Civil Division’s Commercial Litigation Branch, the U.S. Attorney’s Office for the Western District of Texas, HHS OIG and the Defense Criminal Investigative Service. 

The matter was handled by Trial Attorney Jonathan Thrope of the Civil Division’s Commercial Litigation Branch (Fraud Section) and Assistant U.S. Attorney Thomas Parnham for the Western District of Texas.

The claims resolved by the settlement are allegations only and there has been no determination of liability.