Some doctors come to investigators’ attention because a whistleblower cries foul. In other cases, a routine audit expands into a fraud investigation. But the recent sentencing of a Bowling Green, Ky. physician was triggered by a couple of low-revenue tests.
Gott switched to pain management after a long career as a cardiologist. This isn’t an obvious transition and his billing habits brought him to the attention of the U.S. Attorney’s office in Louisville, Covington explained.
“What happened is the agents discovered that Dr. Gott was performing an EKG on every patient, every three months. But it's not something that you usually get, certainly not on a quarterly basis, unless you've got some kind of cardiac problem. And most of Dr. Gott's patients were pain patients,” Covington said.
Gott’s billing for spirometry — which tests lung function — followed the same pattern. Every quarter every patient received the test. However, when agents issued a search warrant, Gott told his staff to stop performing the procedures.
“We think that's a very good indication that those tests were never medically necessary,” Covington said.
Based on Covington’s remarks, it seems the more investigators looked at Gott, the more they found that just didn’t make sense for a pain management provider. In addition to the cardiac and pulmonary tests, there were many things Gott did not do. For example, he didn’t refer the patients for diagnostic MRIs, which would have allowed him to pinpoint the source of their pain.
In addition, he didn’t refer them to or perform other forms of pain treatment, such as physical therapy, before he started them on a regimen of prescription opioids. And finally, Gott didn’t prescribe drugs such as hydrocodone or oxycodone. Methadone was his drug of choice for his patients. While methadone can be used to manage pain, it is more commonly used to treat opioid addiction. Gott was the largest biller of methadone in the area where he practiced.