When the company recruited him, Wagner said, he was told the job offered "potential to earn a great deal of money" from bonuses he would receive from services he generated, including a share of collections from lab services for urine tests done at the new Tennessee facility.
That did not happen, according to Wagner. He is suing CPS, saying that it failed to collect bills for services he rendered and then closed the clinic. CPS refutes Wagner's claims and says it fulfilled its obligations under the contract. In a counterclaim, CPS argues that Wagner owes it $190,000.
"All of their money was being made off of urine drug screens. They weren't doing anything else properly," Wagner said. The lawsuit is pending in federal court in Nashville.
Former CPS chief executive John Davis, in an interview, described the urine-testing lab as part of a "strategic expansion initiative" in which the company invested $6 million to $10 million in computerized equipment and swiftly acquired new clinics. Kroll, one of the owners of CPS, said the idea was to "take the company to the next level."
Davis, who led the initiative before leaving the company in June, would not discuss the private company's finances other than to say CPS is profitable and that lab profits "to a great degree" drove the expansion. "Urine screening isn't the reason why we decided to grow our company. We wanted to help people in need," Davis said.
Kroll acknowledged that urine tests are profit-makers, but stressed that verifying that patients aren't abusing drugs gives him a "whole different level of confidence that I'm doing something right for the patients' condition."
He said his doctors try to be "judicious" in ordering urine tests. Kroll said some of his doctors and nurses treat "high-risk" patients who require more frequent testing. The company said that its Medicare billing practices, including urine screens, had withstood a "very in-depth" government audit. The audit initially called for repayment of $25 million but was settled in 2016 for less than $7,000, according to the company. Medicare officials had no comment.
Kroll's orthopedic career took a sharp turn more than a decade ago after watching his brother suffer through multiple surgeries for muscular dystrophy, along with bone fractures, stiffness and pain. His brother died at age 25, and Kroll decided to switch to anesthesiology and become a pain specialist.
"It sensitized me to the plight of people with chronic conditions that we have no medical answer for," Kroll said. His brother "battled for his whole life."
Kroll's career change coincided with a national movement to establish pain management as a vital medical specialty, with its own accrediting societies and lobbying and political arm to advance its interests and those of patients.
Joined by three other doctors, he formed Comprehensive Pain Specialists at a storefront in suburban Hendersonville, Tenn. It quickly gained a foothold on referrals from local doctors unsure, or uneasy, about treating unyielding pain with heavy narcotics such as oxycodone, morphine and methadone.
In 2014, when CPS was among Medicare's major urine-test billers, Tennessee led the nation in Medicare spending on urine drug tests run by doctors with in-house labs, according to federal billing records.