Tennessee Nurse Agrees to 10 Year Exclusion

TN 2018 Behavioral Health
OIG False Claims Controlled Substance
Penalty
$0

Outcome

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Details

Tennessee Nurse Agrees to 10 Year Exclusion — Settlement

Outcome: Official websites use .gov A .gov website belongs to an official government organization in the United States.

Official websites use .gov A .gov website belongs to an official government organization in the United States.

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On September 14, 2018, Cindy Scott, R.N., A.P.R.N. (Scott), Tennessee, agreed to be excluded from participation in all Federal health care programs for a period of ten years under 42 U.S.C. §§ 1320a-7(b)(6)(B) and 1320a-7(b)(7). OIG alleged Scott submitted or caused the submission of false claims for controlled substance prescriptions that were medically unnecessary, substantially in excess of the needs of her patients, and below the professionally recognized standards of care. Specifically, OIG alleged Scott prescribed monthly prescriptions to individual patients exceeding a daily dosage of five hundred (500) morphine milligram equivalents (MME), which included inappropriate combinations of long and short acting opioids often combined with high amounts of a benzodiazepine and/or carisoprodol. OIG also alleged Scott prescribed controlled substances and combinations of controlled substances and other medication without appropriately documenting: (1) a clear objective finding of a chronic pain source to justify the ongoing and increasing prescribing; (2) attempts to identify the etiology of reported pain; (3) a thorough history or adequately inquiring into potential substance abuse history; or (4) a written treatment plan with regard to the use of the prescriptions. Senior Counsels Andrea Treese Berlin, Katie Fink, and Joan Matlack represented OIG.

HHS Office of Inspector General

How Crucible Prevents This

Crucible's billing compliance controls enforce documentation-to-claims reconciliation, requiring clinical attestation before claims submission and flagging billing patterns that deviate from documented care delivery. Crucible's controlled substance tracking enforces DEA-compliant inventory reconciliation, flags prescribing pattern anomalies, and requires segregation of duties for dispensing and record-keeping.

Source: Tennessee Nurse Agrees to 10 Year Exclusion

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