McMINNVILLE, Tenn. — Each month, Michelle Shaw went to a ache clinic to get the photographs that made her again really feel worse — so she may get the capsules that made her again really feel higher.
Shaw, 56, who has been depending on opioid painkillers since she injured her again in a fall a decade in the past, stated in each an interview with KFF Health News and in sworn courtroom testimony that the Tennessee clinic would write the prescriptions provided that she first agreed to obtain three or 4 “very painful” injections of one other medication alongside her backbone.
The clinic claimed the injections have been steroids that will relieve her ache, Shaw stated, however with every shot her agony would develop. Shaw stated she finally tried to say no the photographs, then the clinic issued an ultimatum: Take the injections or get her painkillers elsewhere.
“I had nowhere else to go at the time,” Shaw testified, in accordance with a federal courtroom transcript. “I was stuck.”
Shaw was amongst 1000’s of sufferers of Pain MD, a multistate ache administration firm that was as soon as among the many nation’s most prolific customers of what it known as “tendon origin injections,” which usually inject a single dose of steroids to alleviate stiff or painful joints. As many medical doctors have been scaling again their use of prescription painkillers as a result of opioid disaster, Pain MD paired opioids with month-to-month injections into sufferers’ backs, claiming the photographs may ease ache and probably reduce reliance on painkillers, in accordance with federal courtroom paperwork.
Michelle Shaw, a former affected person of Pain MD in Tennessee, testified in federal courtroom that the ache clinics threatened to discharge her as a affected person, which might have lower off her painkiller prescriptions and sure despatched her into withdrawal, if she didn’t conform to month-to-month injections in her again, making her ache worse. Shaw was a key witness within the trial of Pain MD president Michael Kestner, who was convicted of 13 felonies associated to well being care fraud in October. Shaw was photographed at her Tennessee house on Jan. 14.(Brett Kelman/KFF Health News)
Now, years later, Pain MD’s injections have been proved in courtroom to be a part of a decade-long fraud scheme that made tens of millions by capitalizing on sufferers’ dependence on opioids. The Department of Justice has efficiently argued at trial that Pain MD’s “unnecessary and expensive injections” have been largely ineffective as a result of they focused the fallacious physique half, contained short-lived numbing drugs however no steroids, and seemed to be primarily based on take a look at photographs given to cadavers — individuals who felt neither ache nor aid as a result of they have been lifeless.
Four Pain MD workers have pleaded responsible or been convicted of well being care fraud, together with firm president Michael Kestner, who was discovered responsible of 13 felonies at an October trial in Nashville, Tennessee. According to a transcript from Kestner’s trial that turned public in December, witnesses testified that the corporate documented giving sufferers about 700,000 complete injections over about eight years and stated some sufferers received as many as 24 photographs directly.
“The defendant, Michael Kestner, found out about an injection that could be billed a lot and paid well,” stated federal prosecutor James V. Hayes because the trial started, in accordance with the transcript. “And they turned some patients into human pin cushions.”
The Department of Justice declined to remark for this text. Kestner’s attorneys both declined to remark or didn’t reply to requests for an interview. At trial, Kestner’s attorneys argued that he was a well-intentioned businessman who wished to run ache clinics that supplied extra than simply capsules. He is scheduled to be sentenced on April 21 in a federal courtroom in Nashville.
According to the transcript of Kestner’s trial, Shaw and three different former sufferers testified that Pain MD’s injections didn’t ease their ache and typically made it worse. The sufferers stated they tolerated the photographs solely so Pain MD wouldn’t lower off their prescriptions, with out which they may have spiraled into withdrawal.
“They told me that if I didn’t take the shots — because I said they didn’t help — I would not get my medication,” testified Patricia McNeil, a former affected person in Tennessee, in accordance with the trial transcript. “I took the shots to get my medication.”
In her interview with KFF Health News, Shaw stated that always she would arrive on the Pain MD clinic strolling with a cane however would go away in a wheelchair as a result of the injections left her in an excessive amount of ache to stroll.
“That was the pain clinic that was supposed to be helping me,” Shaw stated in her interview. “I would come home crying. It just felt like they were using me.”
‘Not Actually Injections Into Tendons at All’
Pain MD, which typically operated below the identify Mid-South Pain Management, ran as many as 20 clinics in Tennessee, Virginia, and North Carolina all through a lot of the 2010s. Some clinics averaged greater than 12 injections per affected person every month, and at the least two sufferers every acquired greater than 500 photographs in complete, in accordance with federal courtroom paperwork.
All these injections added up. According to Medicare information filed in federal courtroom, Pain MD and Mid-South Pain Management billed Medicare for greater than 290,000 “tendon origin injections” from January 2010 to May 2018, which is about seven instances that of every other Medicare biller within the U.S. over the identical interval.
Tens of 1000’s of further injections have been billed to Medicaid and Tricare throughout those self same years, in accordance with federal courtroom paperwork. Pain MD billed these authorities packages for about $111 per injection and picked up greater than $5 million from the federal government for the photographs, in accordance with the courtroom paperwork.
More injections have been billed to non-public insurance coverage too. Christy Wallace, an audit supervisor for BlueCross BlueShield of Tennessee, testified that Pain MD billed the insurance coverage firm about $40 million for greater than 380,000 injections from January 2010 to March 2013. BlueCross paid out about $7 million earlier than it lower off Pain MD, Wallace stated.
These sorts of monumental billing allegations should not unusual in well being care fraud circumstances, during which fraudsters typically discover a official therapy that insurance coverage can pay for after which overuse it to the purpose of absurdity, stated Don Cochran, a former U.S. lawyer for the Middle District of Tennessee.
Tennessee alone has seen fraud allegations for pointless billing of urine testing, pores and skin lotions, and different injections in simply the previous decade. Federal authorities have additionally investigated an alleged fraud scheme involving a Tennessee firm and a whole lot of 1000’s of catheters billed to Medicare, according to The Washington Post, citing nameless sources.
Cochran stated the Pain MD case felt particularly “nefarious” as a result of it used opioids to make sufferers play alongside.
“A scheme where you get Medicare or Medicaid money to provide a medically unnecessary treatment is always going to be out there,” Cochran stated. “The opioid piece just gives you a universe of compliant people who are not going to question what you are doing.”
“It was only opioids that made those folks come back,” he stated.
The allegations towards Pain MD turned public in 2018 when Cochran and the Department of Justice filed a civil lawsuit towards the corporate, Kestner, and several other related clinics, alleging that Pain MD defrauded taxpayers and authorities insurance coverage packages by billing for “tendon origin injections” that have been “not actually injections into tendons at all.”
Kestner, Pain MD, and several other related clinics have every denied all allegations in that lawsuit, which is ongoing.
Scott Kreiner, an skilled on backbone care and ache medication who testified at Kestner’s prison trial, stated that true tendon origin injections (or TOIs) usually are used to deal with infected joints, just like the situation referred to as “tennis elbow,” by injecting steroids or platelet-rich plasma right into a tendon. Kreiner stated most sufferers want just one shot at a time, in accordance with the transcript.
But Pain MD made repeated injections into sufferers’ backs that contained solely lidocaine or Marcaine, that are anesthetic drugs that trigger numbness for mere hours, Kreiner testified. Pain MD additionally used needles that have been typically too brief to achieve again tendons, Kreiner stated, and there was no imaging expertise used to goal the needle anyway. Kreiner stated he didn’t discover any injections in Pain MD’s information that appeared medically obligatory, and even when that they had been, nobody may need so many.
“I simply cannot fathom a scenario where the sheer quantity of TOIs that I observed in the patient records would ever be medically necessary,” Kreiner stated, in accordance with the trial transcript. “This is not even a close call.”
Jonathan White, a doctor assistant who administered injections at Pain MD and skilled different workers to take action, then later testified towards Kestner as a part of a plea deal, stated at trial that he believed Pain MD’s injection method was primarily based on a “cadaveric investigation.”
According to the trial transcript, White stated that whereas working at Pain MD he realized he may discover no medical analysis that supported performing tendon origin injections on sufferers’ backs as an alternative of their joints. When he requested if Pain MD had any such analysis, White stated, an worker responded with a two-paragraph letter from a Tennessee anatomy professor — not a medical physician — that stated it was potential to achieve the area of again tendons in a cadaver by injecting “within two fingerbreadths” of the backbone. This course of was “exactly the procedure” that was taught at Pain MD, White stated.
During his personal testimony, Kreiner stated it was “potentially dangerous” to inject a affected person as described within the letter, which mustn’t have been used to justify medical care.
“This was done on a dead person,” Kreiner stated, in accordance with the trial transcript. “So the letter says nothing about how effective the treatment is.”
Michelle Shaw and her fiancé, Thomas Truss, stated in interviews that Pain MD clinics required sufferers to conform to a number of injections close to their spines every month or be discharged. Shaw begrudgingly accepted the photographs so she wouldn’t lose entry to her painkiller prescriptions, however Truss stated he refused the injections and was “kicked out.” Shaw was a key witness within the trial of Pain MD president Michael Kestner, who was convicted of 13 felonies associated to well being care fraud in October. Shaw and Truss have been photographed at their Tennessee house on Jan. 14.(Brett Kelman/KFF Health News)
Over-Injecting ‘Killed My Hand’
Pain MD collapsed into chapter 11 in 2019, leaving some sufferers unable to get new prescriptions as a result of their medical information have been stuck in locked storage units, in accordance with federal courtroom information.
At the time, Pain MD defended the injections and its follow of discharging sufferers who declined the photographs. When a former affected person publicly accused the corporate of treating his again “like a dartboard,” Pain MD filed a defamation lawsuit, then dropped the swimsuit a few month later.
“These are interventional clinics, so that’s what they offer,” Jay Bowen, a then-attorney for Pain MD, informed The Tennessean newspaper in 2019. “If you don’t want to consider acupuncture, don’t go to an acupuncture clinic. If you don’t want to buy shoes, don’t go to a shoe store.”
Kestner’s trial informed one other story. According to the trial transcript, eight former Pain MD medical suppliers testified that the driving drive behind Pain MD’s injections was Kestner himself, who isn’t a medical skilled and but usually pressured workers to offer extra photographs.
One nurse practitioner testified that she acquired emails “every single workday” pushing for extra injections. Others stated Kestner overtly ranked workers by their injection charges, and implied that those that ranked low could be fired.
“He told me that if I had to feed my family based on my productivity, that they would starve,” testified Amanda Fryer, a nurse practitioner who was not charged with any crime.
Brian Richey, a former Pain MD nurse practitioner who at instances led the corporate’s injection rankings, and has since taken a plea deal that required him to testify in courtroom, stated on the trial that he “performed so many injections” that his hand turned chronically infected and required surgical procedure.
“‘Over injecting killed my hand,’” Richey stated on the witness stand, studying a textual content message he despatched to a different Pain MD worker in 2017, in accordance with the trial transcript. “‘I was in so much pain Injecting people that didnt want it but took it to stay a patient.’”
“Why would they want to stay there?” a prosecutor requested.
“To keep getting their narcotics,” Richey responded, in accordance with the trial transcript.
Throughout the trial, protection lawyer Peter Strianse argued that Pain MD’s deal with injections was a results of Kestner’s “obsession” with making certain that the corporate “would never be called a pill mill.”
Strianse stated that Kestner “stayed up at night worrying” about sufferers coming to clinics solely to get opioid prescriptions, so he pushed his workers to manage injections, too.
“Employers motivating employees is not a crime,” Strianse stated at closing arguments, in accordance with the courtroom transcript. “We get pushed every day to perform. It’s not fraud; it’s a fact of life.”
Prosecutors insisted that this protection rang hole. During the trial, former workers had testified that almost all sufferers’ opioid dosages remained regular or elevated whereas at Pain MD, and that the clinics didn’t taper off the painkillers irrespective of what number of injections got.
“Giving them injections does not fix the pill mill problem,” federal prosecutor Katherine Payerle stated throughout closing arguments, in accordance with the trial transcript. “The way to fix being a pill mill is to stop giving the drugs or taper the drugs.”
Brett Kelman:
[email protected],
@BrettKelman
Related Topics
src=”//platform.twitter.com/widgets.js” charset=”utf-8″>
