NASHVILLE, Tenn. (WKRN) — A Tennessee man was convicted by a federal jury Thursday on more than a dozen charges for his role in a $35 million fraud scheme involving "medically unnecessary injections," officials said.
According to the U.S. Department of Justice (DOJ), 72-year-old Michael Kestner, of Nashville, owned, operated and managed pain clinics in several states, including Tennessee, North Carolina, and Virginia, which were all branded under the name Pain MD.
During his tenure, officials said Kestner fraudulently billed federal health care programs approximately $35 million for "medically unnecessary injections, which were administered over the course of eight years to a population of opioid-dependent patients."
According to evidence that was presented at the trial, Kestner is not a physician and instead pressured nurse practitioners and physician assistants employed by Pain MD to provide back injections to patients who came to the clinic seeking opioid treatment.
Additionally, witnesses reportedly testified that patients who refused to accept regular injections risked being sent sway from the clinic and suffering withdrawals from their opioid addiction.
The DOJ said evidence revealed that the injections were billed as Tendon Origin Insertion injections (TOIs). However, almost none of the patients were diagnosed with pain in their tendons, officials said.
To keep the billings up, Kestner allegedly sent emails ranking the practitioners "production" against one another, criticizing providers if they had a "below average performance." He is also accused of ignoring notices, including a lawsuit, from insurance companies alerting him that his clinics were billing injections wrong.
Through the practices, Pain MD reportedly became Medicare's single highest biller of TOI procedures in the country, outranking the next highest biller "eightfold."
Kestner was convicted of one count of conspiracy to commit health care fraud and 12 counts of health care fraud. He is scheduled to be sentenced on Feb. 27, 2025, and faces up to 10 years in prison for each count, according to the DOJ.
The matter is being investigated by the Department of Health and Human Services, Office of Inspector General, Defense Criminal Investigative Service Southeast Field Office, the Department of Veterans Affairs of Inspector General and the Tennessee Bureau of Investigation.
from WKRN News 2 https://ift.tt/try8C5g
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