On April 11, 2024, a jury convicted Northern Kentucky Center for Pain Clinic owner Dr. Timothy Ehn (who was not a medical doctor) and medical director, Dr. William Lawrence Seifert, for their roles in a scheme that defrauded Medicare, Medicaid and commercial insurance companies of over $4 million for medically unnecessary urine drug testing.

According to the indictment, the Government alleged that Dr. Ehn and Dr. Seifert directed their employees to perform both presumptive and definitive urine testing from patients during office visits. Presumptive urine testing identifies which substances, if any, are present in the urine specimen and is usually performed via a cup and the results read by direct optical observation. Presumptive urine testing is generally deemed to be medically necessary in the treatment of chronic pain patients by federal health care programs and therefore, appropriately reimbursable. However, federal payors do not consider “blanket orders” or routine presumptive testing medically necessary.

Definitive urine testing is more complex than presumptive testing. Generally, for definitive testing, the specimen may be sent to a laboratory for analysis and test results will identify the amount of a particular substance that was provided in the specimen. Federal payors consider definitive testing to be medically necessary, and appropriately reimbursable, in the treatment of chronic pain to certain limited circumstances, including when members or beneficiaries had a specific and documented need for definitive testing. Similar to presumptive testing, federal payors do not consider “blanket orders” or routine presumptive testing medically necessary.

The government alleged that Dr. Seifert and Dr. Ehn engaged in a scheme to bill for medically unnecessary urine drug tests. According to DOJ, Dr. Ehn and Dr. Siefert continued in their scheme even though their expensive drug testing machine malfunctioned and caused the machine to produce results that falsely suggested patients were testing positive for street drugs like ecstasy or heroin. Insurance proceeds from urine drug testing ended up comprising three-quarters of the clinic’s revenue.

The indictment also alleged that Dr. Ehn and Dr. Siefert prescribed opioids and other controlled substances to patients who should not have received the prescriptions. According to the indictment, seven patients died of opioid overdoses shortly after receiving prescriptions written by Dr. Siefert yet the clinic did not change its prescribing practices.

As a result of their schemes, Dr. Siefert, 70, was sentenced to one year and six months in prison and ordered to pay $1,968,763.10. Dr. Ehn, 51, was sentenced to two years and ordered to pay $3,773,569.30 in restitution.

For additional information, read the Indictment and DOJ’s press release.

Reddy’s Rule #2:

Learning about prosecutions by the Government help providers understand areas of enforcement, risks and general awareness of relevant issues. If you are a provider that conducts urine testing, evaluate your current practices and policies to ensure that the urine testing is medically necessary and that the type of urine testing being conducted is medically appropriate and properly documented in the patient’s medical file.

 Be well.