A federal jury has found a Tennessee man guilty on multiple charges related to a $35 million fraud scheme that centered around unnecessary injections, according to officials.
According to the US Department of Justice (DOJ), 72-year-old Michael Kestner of Nashville owned, maintained, and managed pain clinics in numerous states, including Tennessee, North Carolina, and Virginia, all under the Pain MD brand.
Officials claimed Kestner illegally billed federal health care programs for $35 million in “medically unnecessary injections, administered over the course of eight years to a population of opioid-dependent patients” during his employment.
Evidence from the trial shows that Kestner, who is not a doctor, pressured Pain MD’s nurse practitioners and physician assistants to give back injections to patients who came to the clinic for opioid treatment.
Witnesses reportedly testified that patients who refused to receive regular injections risked being discharged from the clinic and experiencing opioid withdrawal symptoms.
The DOJ stated that evidence suggested that the injections were marketed as Tendon Origin Insertion Injections (TOI). Almost none of the patients received a diagnosis of tendon discomfort, according to officials.
To keep billings up, Kestner allegedly sent emails measuring practitioners’ “production” against one another, penalizing providers for “below average performance.” Insurance companies, including a lawsuit, have accused him of ignoring letters informing him that his clinics were billing injections incorrectly.
Pain MD allegedly became Medicare’s single biggest biller of TOI procedures in the US, outranking the second highest biller “eightfold.”
The court found Kestner guilty of one count of conspiracy to commit healthcare fraud and twelve counts of healthcare fraud. The DOJ has scheduled his sentence for February 27, 2025, and he may face up to ten years in jail for each offense.
The Department of Health and Human Services’ Office of Inspector General, the Defense Criminal Investigative Service Southeast Field Office, the Department of Veterans Affairs’ Inspector General, and the Tennessee Bureau of Investigation are all investigating the case.
