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Pain Management Doctor, Practice to Pay $13,625,000 to Settle Civil False Claims Act Allegations

Dr. Mark Malone, Advanced Pain Care, and related entities have agreed to pay the United States and the State of Texas $13,625,000 to resolve allegations they submitted false claims for urine drug testing to federal and state healthcare programs. The United States will receive $13,590,544.88 and Texas will receive $34,455.12. The United States alleged that Dr. Malone and Advanced Pain Care knowingly submitted false claims to Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program for concurrent presumptive and definitive urine drug testing for the same patient on the same date of service, without reviewing the results of the presumptive test to determine whether a definitive test was medically necessary. The United States also alleged that Dr. Malone and Advanced Pain Care knowingly submitted false claims to the Department of Veterans Affairs for definitive drug testing using separate Current Procedural Terminology (CPT) codes for individual analytes (i.e., CPT series 803XX) for dates of service between January 3, 2017, and December 31, 2021.