Life can be full of fears. Many of us probably share a lot of the same worries. Maybe the fear of failure. Maybe the fear of losing a job. Maybe, for some, the fear of not getting their medical needs met. All real and valid fears, and ones that Michael Kestner manipulated in order to operate a scheme that stole over $35 million from the U.S. taxpayer. But fear can backfire, as Michael Kestner is discovering.
Kestner owned several pain clinics under the brand Pain MD. He is not a doctor, but you don’t need to be a doctor to own medical facilities, nor to commit Medicare fraud. Kestner pressured nurse practitioners and physician assistants employed by clinics in the Pain MD network to provide multiple back injections to most of the patients who came to Pain MD seeking opioid treatment. The injections were billed as Tendon Origin Insertion Injections (TOI), even though almost none of these patients were diagnosed with pain in their tendons. Patients who refused to accept regular injections risked being turned away from Pain MD and suffering withdrawals from their opioid medication. Practitioners who refused to provide unnecessary injections risked losing their job.
To encourage administration of the shots, Kestner would send email to employees, ranking their “production” against others and criticizing them if they fell “below average,” unlocking fraud potential and unleashing individual results! He ignored repeated notices from insurance companies alerting him that his clinics were improperly billing these injections. Through these practices, Pain MD became Medicare’s single highest biller of TOI procedures in the country, billing eight times as many as the next highest.
On November 1, 2024, Kestner was found guilty of health care fraud.
Excellent job by the Department of Health and Human Services Office of Inspector General (HHS-OIG) in this case.
Today’s Fraud of The Day is based on article “Nashville Pain Clinic Owner Convicted For $35 Million Healthcare Fraud” published by the Tennessee Conservative on November 1, 2024.
A federal jury has convicted a Nashville man on more than a dozen charges for his involvement in a $35 million healthcare fraud scheme. According to the U.S. Department of Justice, 72-year-old Michael Kestner served as the owner, operator, and manager of a number of pain clinics in several states. In Tennessee, North Carolina, and Virginia, those clinics were under the Pain MD.
Officials say that over a 10-year-period, Kestner fraudulently billed federal health care programs for “medically unnecessary injections…to a population of opioid-dependent patients.” The bills totaled approximately $35 million.
