An Austin-based pain management doctor and his medical practice have agreed to pay more than $13.6 million to settle allegations that they improperly billed federal and state health care programs for urine drug testing, according to federal prosecutors.
Dr. Mark Malone, the founder of Advanced Pain Care, and more than a dozen related entities will pay $13.6 million to the United States and the state of Texas to resolve the claims under the federal False Claims Act and Texas law.
The federal government will receive the vast majority of the settlement, while Texas will receive about $34,000, officials said.
Advanced Pain Care operates pain medicine clinics and surgical centers across Texas, including locations in Austin, Amarillo, Waco and Houston. Malone is an interventional pain management physician who founded the practice.
Federal authorities alleged that from 2017 through 2021, Malone and Advanced Pain Care knowingly submitted false claims to Medicare, Medicaid, TRICARE and other government health programs for urine drug tests that were not medically necessary. Prosecutors said the practice billed for both preliminary and more advanced drug tests on the same patients and dates of service without first reviewing initial results to determine whether further testing was warranted.
The government also alleged the practice used multiple billing codes for individual drug analytes when billing the Department of Veterans Affairs, inflating reimbursements.
U.S. Attorney Justin Simmons said in a statement that while medical professionals take an oath to do no harm, it didn’t stop Advanced Pain Care from allegedly committing these violations.
“Some, like Dr. Malone, instead cause harm by submitting false claims for procedures, thereby enriching themselves to the detriment of the American taxpayer,” Simmons said. “These settlements demonstrate my office’s commitment to protect the healthcare programs on which the American people have come to rely.”
As part of the settlement, Advanced Pain Care entered into a five-year corporate integrity agreement with the U.S. Department of Health and Human Services Office of Inspector General. The agreement requires the practice to strengthen compliance oversight, conduct risk assessments and retain an independent organization to review billing claims.
The settlement resolves allegations raised in five lawsuits. Officials emphasized that the claims are allegations only and that no determination of liability was made.