The Franklin-based Rinova The Wellness Group, PC has settled the federal government’s allegations that Medicare overpaid the company for claims that were non-payable due to fraudulent misrepresentations.
This, according to a press release the U.S. Attorney’s Office for the Middle District of Tennessee released this week.
The government alleged that Rinova misrepresented that it had provided services, when they were actually a continuation of services by the suspended company Pain MD, LLC, according to the press release.
U.S. Attorney Don Cochran for the Middle District of Tennessee (pictured above) announced:
In 2019, Rinova, led by former Pain MD physician Ben Johnson, acquired certain Tennessee assets of Pain MD clinics and leased other Virginia as sets of Pain MD clinics. At the time, Medicare contractors had suspended all payments to Pain MD, based on credible allegations of fraud. Rinova obtained new Medicare payment numbers, which according to the United States, amounted to an attempt to evade the Medicare payment suspension of Pain MD, so that Rinova could improperly obtain Medicare reimbursements while operating Pain MD’s Tennessee and Virginia pain clinics using the same Pain MD employees, clinics, locations, and patients.
“The Medicare contractor suspended payments to Rinova in June 2019 and revoked Rinova’s billing privileges in September 2019,” Cochran said; adding, “Rinova has now ceased its operations and no longer operates any pain clinics in Tennessee or elsewhere. The settlement resolves the government’s claims that it overpaid Rinova for all of its services. Under the settlement agreement, Rinova waived its claim to $379,961 in suspended Medicare payments, forfeited $49,112, and paid an additional $53,151. The settlement has a total value of $482,224.”
The Tennessee Bureau of Investigation’s Medicaid Fraud Control Unit and the Department of Health and Human Services, Office of Inspector General investigated the matter, the press release said.
As The Tennessee Star reported in March, state officials charged three people, a married couple from Williamson County and a Knox County man, with TennCare fraud.
Tennessee Department of Finance and Administration officials announced this in separate press releases last week.
Authorities charged the Williamson County couple, Heidi Smith, 42, and her husband Robert Smith, 42, both from Franklin, with TennCare fraud and theft of services related to information they allegedly provided to the state for TennCare eligibility. Those authorities charged Heidi Smith with TennCare fraud and theft of services over $10,000 but under $60,000. Robert Smith, a dentist, faced the same theft of services charge.
“Heidi Smith allegedly provided false information related to her household income in order to obtain TennCare healthcare insurance benefits for herself, her husband and their five children,” an F&A press release said.
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Chris Butler is an investigative journalist at The Tennessee Star. Follow Chris on Facebook. Email tips to [email protected].
$379,961.00 in “Suspended Payments“. So they did not get paid. Unlike Cherokee Health, who improperly billed TennCare over 7 million dollars, got paid, and entered into an agreement to repay while continuing to get paid…… Taxpayers are funding the repayment of billing irregularities.