United States of America ex rel. Krista Nicholson v. Clarksville Pain Institute, LLC; Pain Institute of Nashville, PLC; Michael Cox; and Debbie Cox

CourtDistrict Court, M.D. Tennessee
DecidedApril 2, 2026
Docket3:20-cv-00309
StatusUnknown

This text of United States of America ex rel. Krista Nicholson v. Clarksville Pain Institute, LLC; Pain Institute of Nashville, PLC; Michael Cox; and Debbie Cox (United States of America ex rel. Krista Nicholson v. Clarksville Pain Institute, LLC; Pain Institute of Nashville, PLC; Michael Cox; and Debbie Cox) is published on Counsel Stack Legal Research, covering District Court, M.D. Tennessee primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
United States of America ex rel. Krista Nicholson v. Clarksville Pain Institute, LLC; Pain Institute of Nashville, PLC; Michael Cox; and Debbie Cox, (M.D. Tenn. 2026).

Opinion

IN THE UNITED STATES DISTRICT COURT FOR THE MIDDLE DISTRICT OF TENNESSEE NASHVILLE DIVISION

UNITED STATES OF AMERICA ex rel. ) KRISTA NICHOLSON, ) ) Plaintiff, ) ) v. ) Case No. 3:20-cv-00309 ) Judge Aleta A. Trauger CLARKSVILLE PAIN INSTITUTE, LLC, ) PAIN INSTITUTE OF NASHVILLE, PLC, ) MICHAEL COX, and DEBBIE COX, ) ) Defendants. )

MEMORANDUM The United States has filed a Motion to Amend Complaint-in-Intervention (Doc. No. 98), which, for the reasons set forth herein, will be granted. I. PROCEDURAL HISTORY Relator Krista Nicholson filed a qui tam Complaint under seal in April 2020, alleging fraud schemes and False Claim Act (“FCA”) violations. (Doc. No. 1.) In July 2024, the United States (the “government”) elected to intervene in part (Doc. No. 60) and filed a Complaint-in-Intervention (“Complaint”) in September 2024 (Doc. No. 65).1 The government asserted claims under the FCA and federal common law claims for payment by mistake and unjust enrichment against defendants Clarksville Pain Institute, LLC; Pain Institute of Nashville, PLC; Michael Cox; and Debbie Cox. (Compl. at 1, ¶¶ 366–77.) The court then granted two Motions to Dismiss the government’s

1 Over almost four years, the court granted the government’s nine motions to extend the time to consider intervention. (Doc. Nos. 19 (July 13, 2020), 23, 26, 30, 38, 42, 48, 56, 59 (May 2, 2024).) Complaint: one filed by the Clarksville Pain Institute and the Pain Institute of Nashville (Doc. No. 75), and the other filed by Michael Cox and Debbie Cox (the “Cox defendants”) (Doc. No. 79). (Doc. No. 90 (dismissing all claims against the defendants in the United States’ Complaint without prejudice).) In pertinent part, the court found that the government’s Complaint did not meet Rule

9(b)’s heightened standard for pleading fraud as to the Cox defendants. (Doc. No. 89 at 36–37.) One week later, the United States filed a Motion to Set Deadline for Amended Complaint (Doc. No. 93), which the court granted over the Cox defendants’ objections. (Doc. Nos. 94, 96.) Now before the court is the government’s timely-filed Motion to Amend Complaint-in- Intervention (“Motion to Amend”) (Doc. No. 98), the proposed Amended Complaint-in- Intervention (“Amended Complaint”) (Doc. No. 98-1), and a Memorandum in support (Doc. No. 99), to which the Cox defendants have filed a Response (Doc. No. 101) along with the Declaration of their counsel (Doc. No. 102) and Exhibits (Doc. Nos. 102–1 through 102-4), and in further support of which the government has filed a Reply (Doc. No. 103). In addition, the United States has filed a Notice of Supplemental Authority, to which the Cox defendants have filed a Response.2

(Doc. Nos. 106–107.) II. LEGAL STANDARD – RULE 15(a) Rule 15(a) permits a party to amend its pleading “once as a matter of course” within twenty- one days after serving it or twenty-one days after service of a responsive pleading or certain Rule 12 motions. Fed. R. Civ. P. 15(a)(1). Once that window closes, a party may amend its pleading

2 The United States alerted the court to the Sixth Circuit’s decision in United States v. Siefert, 161 F.4th 379 (6th Cir. 2025), which was issued after the parties finished briefing the Motion to Amend. (Doc. No. 106 at 1.) Siefert is a criminal case. In their Response, the Cox defendants argued that Seifert is irrelevant to the pending Motion to Amend and referred the court, instead, to a First Circuit decision issued after briefing concluded. (Doc. No. 107 at 1, 2 n.1 (describing United States ex rel. Flanagan v. Fresenius Medical Care Holdings, Inc., 142 F.4th 25 (1st Cir. 2025)).) only with the opposing party’s consent or by leave of court, and the “court should freely give leave when justice so requires.” Fed. R. Civ. P. 15(a)(2). “The Rule’s ‘purpose is to provide maximum opportunity for each claim to be decided on its merits rather than on procedural technicalities.’” BLOM Bank SAL v. Honickman, 605 U.S. 204, 213 (2025) (quoting 6 Wright, Miller, & Kane,

Federal Practice and Procedure § 1471 (3d ed. 2010)). Thus, Rule 15(a)(2) “embodies a ‘liberal amendment policy.’” Brown v. Chapman, 814 F.3d 436, 442 (6th Cir. 2016) (quoting Morse v. McWhorter, 290 F.3d 795, 800 (6th Cir. 2002)). As the Sixth Circuit has stated, “[t]ypically, ‘a plaintiff must be given at least one chance to amend the complaint before the district court dismisses the action with prejudice.’” McGowan v. Herbert, No. 22-2033, 2023 WL 2945341, at *4 (6th Cir. Apr. 14, 2023) (quoting United States ex rel. Bledsoe v. Cmty. Health Sys., Inc., 342 F.3d 634, 644 (6th Cir. 2003)). At the same time, however, once the court has resolved a Rule 12(b)(6) motion, “it is a stretch to say justice requires granting leave to cure the complaint’s deficiencies . . . even where the [district court’s] order turned on a failure to meet Rule 9(b)’s particularity requirements.” United States ex rel. Ibanez v. Bristol-

Myers Squibb Co., 874 F.3d 905, 918 n.2 (6th Cir. 2017) (emphasis added) (citing United States ex rel. SNAPP, Inc. v. Ford Motor Co., 532 F.3d 496, 509 (6th Cir. 2008)). Notwithstanding the liberality with which courts generally are to approach motions to amend, “a court need not grant a motion to amend when the reason for amendment is improper, ‘such as undue delay, bad faith or dilatory motive on the part of the movant, repeated failure to cure deficiencies by amendments previously allowed, undue prejudice to the opposing party by virtue of allowance of the amendment, futility of amendment, etc.’” Greer v. Strange Honey Farm, LLC, 114 F.4th 605, 617 (6th Cir. 2024) (quoting Skatemore, Inc. v. Whitmer, 40 F.4th 727, 737 (6th Cir. 2022)). III. DISCUSSION The United States contends generally that it adds “factual detail the Court found lacking,” including “information from employees and patients” and “material about each of the Coxes.” (Doc. No. 99 at 3–4.) For example, the Amended Complaint adds information from former employees and a patient regarding the alleged “Psychological Testing Scheme.” (Am. Compl.

¶¶ 286–89, 291.) The Cox defendants argue that the court should deny the government’s Motion to Amend because it would unduly prejudice them and because it was brought in bad faith. (Doc. No. 101 at 9–20.) A. Undue Prejudice To deny leave to amend, “a court must find ‘at least some significant showing of prejudice to the opponent.’” Ziegler v. Aukerman, 512 F.3d 777, 786 (6th Cir. 2008) (quoting Moore v. City of Paducah, 790 F.2d 557, 562 (6th Cir.1986)).

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Bluebook (online)
United States of America ex rel. Krista Nicholson v. Clarksville Pain Institute, LLC; Pain Institute of Nashville, PLC; Michael Cox; and Debbie Cox, Counsel Stack Legal Research, https://law.counselstack.com/opinion/united-states-of-america-ex-rel-krista-nicholson-v-clarksville-pain-tnmd-2026.