Oregon Medical Board Accuses Pain Clinic Owner of Defrauding Insurers

The Oregon Medical Board is accusing Dr. Poly Chen, the owner of a chain of Willamette Valley pain clinics, of insurance fraud.

As WW reported in this week’s paper, Providence Health Plan had previously sued Pain Care Specialists of Oregon, demanding the return of $1 million in excessive charges for unnecessary COVID tests. PCSO has denied any wrongdoing. Chen did not respond to WW’s request for comment.

Yesterday, following WW’s report, the Oregon Medical Board released the findings from a year-and-a-half-long investigation into Chen’s billing practices. The board concluded that Chen engaged in “unprofessional or dishonorable conduct” and made “fraudulent” insurance claims. It is threatening disciplinary sanctions, which can include fines up to $10,000 and the revocation of Chen’s license to practice medicine.

The charging document includes new details describing how the board says Chen pulled off the scheme.

Along with patients Chen was testing himself, employees and family members, sometimes dozens of times. The document says Chen “routinely performed two COVID-19 tests for each patient each time the patient entered the clinic.”

The charging document says Chen performed the tests on an Abbott ID Now machine, which can perform a test ever 12 minutes and requires minimal training to operate. Despite this, Chen used a special billing code meant for much more complicated, higher-throughput machines. By doing so, he billed “in the most lucrative way possible,” the board found.

The result, the board says: Chen was charging for an office visit, a $2,500 lab fee and a $2,500 test. Statewide, at the time, the median payment for a COVID test was $108.

The board concluded that Chen not only gave unnecessary tests, but was also involved in setting the outrageous prices. He’d contracted out billing to Oregon Billing and Collections, which is owned by Chen’s wife and operates out of the same office as Pain Care.

It also found that Chen violated state labor guidelines by billing employee’s insurance for COVID tests. “Oregon Bureau of Labor and Industry guidelines provide that employers are generally required to pay any out-of-pocket expenses for a medical exam they require,” the board noted.

By doing so, Chen “made fraudulent claims to insurance companies,” the board concluded.