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- calendar_today November 14, 2026
Federal Prosecutors Announce Major False Claims Act Settlement
The U.S. Attorney's Office for the Middle District of Tennessee has agreed to a $1.5 million settlement with two Tennessee pain clinics and their managers, resolving federal allegations of improper Medicare and Veterans Affairs (VA) billing for unnecessary diagnostic testing. The case involved Clarksville Pain Institute and Pain Institute of Nashville and centered on claims submitted over a decade-long period from 2014 to 2024.
Allegations of Unnecessary Medical Testing
According to the U.S. Department of Justice (DOJ), federal prosecutors alleged that Michael and Debbie Cox, associated with the aforementioned clinics, submitted claims for medically unnecessary diagnostic tests. These included urine drug testing, allergy testing, and psychological testing, all billed to Medicare and the VA. Debbie Cox reportedly held an ownership stake in both clinics, which merged in 2018, per DOJ information.
Federal Efforts to Protect Health Care Program Integrity
U.S. Attorney Braden Boucek emphasized the government’s commitment to safeguarding public healthcare resources. He stated, "Federal health care programs exist to provide necessary medical care, not to generate payments for unnecessary testing. When providers allegedly misuse these programs for financial gain, they undermine public trust and divert taxpayer dollars from legitimate patient care." Boucek reiterated that the office will continue working with federal partners to hold those accountable who submit false health care claims.
Whistleblower Litigation Leads to Settlement
The $1.5 million settlement was reached as a result of whistleblower litigation initiated by Krista Nicholson, a former clinic employee. Nicholson filed her lawsuit under the False Claims Act, which permits private individuals to sue on the government’s behalf over false claims. As a result of her efforts, the DOJ noted that Nicholson will receive $285,000 from the settlement.
Broader Federal Enforcement and Recent False Claims Act Recoveries
This case is part of a broader pattern of federal enforcement in Tennessee regarding false or fraudulent claims against government programs. Between September 30 and October 22, East Tennessee prosecutors announced three additional settlements arising from False Claims Act litigation, resulting in a total of $8.3 million recovered for taxpayers. One such case involved a Chilean-owned plastics company in Knoxville repaying $2.25 million after allegedly failing to count its foreign workforce when seeking a Paycheck Protection Program (PPP) loan during the COVID-19 pandemic.
Ongoing Vigilance Against Medicare and VA Billing Fraud
The U.S. Attorney’s Office and the Department of Justice continue to signal their commitment to deterring and penalizing improper billing practices. These settlements, particularly those related to the submission of claims for unnecessary medical services or diagnostic testing, underscore ongoing federal efforts to ensure the integrity of programs like Medicare and the VA.
Source: tennesseestar.com.
