The owner and operator of “Pain MD” clinics was convicted of defrauding federal programs of $35 million for administering ‘medically unnecessary’ pain injections to opioid-dependent patients, including veterans and troops, according to the Justice Department. (Justice Department)
WASHINGTON — The 72-year-old owner and operator of several medical clinics specializing in pain management was convicted of bilking federal programs of $35 million for medically unnecessary injections given to opioid-dependent patients, including veterans and troops, according to the Justice Department.
Michael Kestner of Nashville, Tenn., who ran “Pain MD” clinics in North Carolina, Tennessee, Virginia and other states, was found guilty last week in U.S. District Court Middle District of Tennessee of one count of conspiracy to commit health care fraud and 12 counts of health care fraud.
Kestner conspired between 2010 and 2018 to submit false and fraudulent claims to Medicare, Medicaid and Tricare — a Defense Department health care program for service members, military retirees and their families, according to court documents.
Kestner, who was not a physician, imposed quotas and pressured nurses and other clinical staff to give frequent shots for tendonitis to patients seeking opioid medication, according to federal officials.
Kestner directed staff to perform “a high number of medically unnecessary injections into patients’ back muscles” for the purpose of receiving higher reimbursements, according to court documents. Patients also were pressured to receive the injections.
“Witnesses testified that patients who refused to accept regular injections risked being turned away from Pain MD and suffering withdrawals from their opioid medication,” according to the Justice Department.
Kestner became Medicare’s single highest biller for so-called “tendon-origin insertion” procedures in the nation in an eight-year period, though most of the patients did not have a diagnosis for tendonitis, federal officials said.
“Kestner relentlessly pressured the providers at his clinics to administer and bill for injections. The evidence also demonstrated that to keep billings up, Kestner sent regular emails ranking the practitioners’ production [and] making providers feel they would lose their jobs or let down their clinic staff if they did not perform an increasing number of injections,” the Justice Department said.
Prosecutors argued the clinics lacked the proper medical equipment to perform back injections along the spine as detailed in patient medical records. The type of medication administered was not identified.
Kestner was owner and president of MedManagement Inc., which was the majority owner of Pain MD, headquartered in Franklin, Tenn.
A 2019 indictment stated, “Pain MD held itself out to be an interventional pain management practice, meaning that it claimed to provide pain management services that were intended to reduce patient reliance on opioids and other narcotic pain medications, when, in fact, these services were intended to increase Pain MD’s revenues and enrich the defendants.”
Kestner could face up to 10 years in prison for each count. His sentencing is scheduled for Feb. 27, 2025.
Participating in the investigation were the Department of Health and Human Services Office of Inspector General, the Defense Criminal Investigative Service, the Department of Defense Office of Inspector General, the Department of Veteran Affairs Office of Inspector General and the Tennessee Bureau of Investigation.
