Tennessee Pain Management Sheds Light on Crisis

In July 2018, the Tennessee-based Comprehensive Pain Specialists (CPS) practice announced that it would be shuttering its clinics. As one of the largest pain management groups in the Southeastern United States, CPS has treated thousands of patients and employed hundreds of personnel. At its peak, CPS operated over 50 clinics in Tennessee and other southern states like Arkansas, Kentucky, Mississippi, and North Carolina. Several Midwestern states were also served by CPS clinics; clinics were located in Ohio, Illinois, and Indiana.

A host of problems have influenced this surprise closure. Financial troubles at the sprawling Nashville-headquartered company were aggravated by a federal criminal investigation that put the company’s former chief executive in the crosshairs. A nationwide opioid shortage has also led to significant challenges for this and other pain management specialists like it.

Legal Challenges at Comprehensive Pain Specialists

In April 2018, a federal grand jury swore out an indictment against John Davis, the former CEO of Comprehensive Pain Specialists. The indictment centered on charges of criminal kickbacks; Davis has pleaded not guilty of the charges against him. Pain management clinics across the country have faced similar scrutiny; many so-called “pill mills” were based on a criminal practice of insurance fraud and monetary kickbacks, treating as many patients as they could to bolster revenue. CPS may not have partaken in such criminal misdeeds, but the charges against Davis certainly influenced public perception of the clinical practice.

Other legal issues have impacted the clinical practice since its founding in 2005. Over a dozen contractors of the company have filed civil lawsuits, alleging unpaid debts. Two of the suits filed against CPS were brought by former physicians of the company. According to federal regulatory officials at the Justice Department, the clinics closure was not related to the criminal proceedings or the lawsuits.

In November 2017, an investigation by Kaiser Health News uncovered unusual Medicare billing practices at the CPS clinics. Urine drug screening by the clinic system resulted in $11 million in payments by Medicare in the year 2014; one healthcare provider was responsible for $1.1 million in urine screening bills that year. In 2015, the CEO and medical director of the company billed Medicare for $1.8 million in urine screening. Faced with scrutiny over the allegations, the clinic stated that it utilized this screening method to prevent black-market sales of opioid drugs by its patients.

The Opioid Crisis and Nationwide Shortage of Opioid Drugs

In the United States, a sharp uptick in opioid-related overdose deaths has led the medical community and federal/state regulators to declare an “opioid crisis”. Some of the thousands of overdose deaths stem from over-prescription of powerful pain-relieving medications, while many others were caused by illicit drug use.

Economic analysts suggest that over $1 trillion has been spent on expenses related to the opioid crisis. These expenses include law enforcement and intervention, lawsuits, and medical costs in both treating overdoses and preventative solutions. Since 1999, the Centers for Disease Control have reported over 200,000 overdose deaths.

Despite the rise of overdose deaths in the U.S., there exists a shortage of opioid drugs in the medical community. One of the leading manufacturers of pain medications has had issues with laboratory accreditation and processes, sharply curtailing production of opioid-based drugs.

Ramifications of the Clinic Closures

Thousands of patients of the CPS practice have scrambled to find medical practitioners to continue treatment. Many physicians are wary of prescribing opioid drugs due to the crisis and increased scrutiny by federal and state pharmaceutical regulators. This has caused many former patients of CPS and similar pain management clinics to turn to black market sources for drugs. When opioid drugs cannot be obtained, either legally or illicitly, patients have resorted to illegal drugs like heroin to conquer chronic pain. This, of course, has led to many other cases of overdoses, including fatal overdoses.

Reputable pain management specialists know that interventional therapies must include options other than prescribing potentially dangerous opioid drugs. Innovative treatments like neurostimulation, nerve blocks, and physical therapy have shown great promise in treating chronic pain without the harmful side effects and risk of overdose. Pain management specialists continue to investigate safe, effective alternatives to powerful pain relieving medications.

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