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Pain MD’s Alleged Scheme Exposed: A Deep Dive into Opioid Dependency and Healthcare Fraud

McMinnville, Tennessee — Michelle Shaw, aged 56, recounted her troubling experiences with Pain MD clinics, where she endured painful injections in a desperate attempt to continue receiving opioid prescriptions necessary for managing her chronic back pain. After a significant injury a decade ago, Shaw became reliant on painkillers but faced an ultimatum from the clinic: accept multiple painful injections each month or lose access to her medication.

In court, Shaw reflected on her predicament: “I had nowhere else to go at the time. I was stuck.” In her testimony and in discussions with KFF Health News, she described the injections as exceedingly painful, leaving her even more distressed than before. The injections, purportedly steroids, contradicted claims of relief; instead, they compounded her suffering. Shaw indicated that deferring the injections resulted in threats of discharge from the clinic, further entrenching her in a cycle of dependency.

Pain MD, which expanded across multiple states, was notorious for its aggressive billing practices, coupling opioid prescriptions with what it marketed as “tendon origin injections.” This practice became increasingly scrutinized, especially as the opioid crisis catalyzed a shift away from over-prescribing pain medications. However, Pain MD positioned these injections as an alternative treatment to reduce reliance on narcotics, drawing thousands of patients into its web.

Following a lengthy investigation, the Department of Justice established that Pain MD’s injections were part of a fraudulent scheme that exploited patient vulnerabilities. Court proceedings revealed the injections were largely ineffective, containing short-lived anesthetics rather than the claimed steroids, and were often directed at incorrect areas of the body. Evidence included staggering statistics indicating the company had administered nearly 700,000 injections over a period of roughly eight years.

A Fraudulent Model Unraveled

The legal unraveling of Pain MD began with allegations in 2018, culminating in the conviction of its president, Michael Kestner, on 13 felonies tied to healthcare fraud. During the trial, testimonies confirmed Kestner’s role in prioritizing injections as a revenue stream, effectively turning patients into “human pin cushions,” as described by federal prosecutor James V. Hayes.

Witness testimony illustrated that many patients submitted to painful injections solely to continue receiving their opioid medications, fearing withdrawal if they ceased attending the clinic. Patricia McNeil, another former patient, echoed similar sentiments, stating, “I took the shots to get my medication.” This manipulative practice drew concern from healthcare professionals, revealing the lengths to which patients went to maintain access to medication.

Historical billing data showcased the substantial fraud Pain MD inflicted on both government and private insurance, with staggering figures reflecting an unsettling trend in healthcare practices. The total billed amounted to hundreds of thousands of injections at inflated prices, with significant reimbursements pocketed by Pain MD while patient welfare deteriorated.

Critique of Treatment Methods

Scott Kreiner, an expert in pain medicine, delineated the appropriate use of tendon origin injections, emphasizing that they’re typically reserved for specific joint conditions and seldom require repeated administration. Under cross-examination, Kreiner distanced Pain MD’s practices from accepted medical standards, asserting that the clinic’s methods bordered on negligent.

Even Kestner’s defense attempted to frame the narrative as an oversight rather than criminality. His legal team suggested that Kestner’s drive for diversified treatments stemmed from a legitimate desire to help patients, yet the overwhelming evidence of intentional over-prescription of both injections and opioids posited a stark counterargument. Testimonies from former employees portrayed a workplace culture that prioritized profit over patient care, with Kestner demanding more injections to meet financial objectives.

Impact on Patients and Staff

Pain MD’s operations buckled under scrutiny, collapsing into bankruptcy in 2019. This downfall left numerous patients without crucial medical records and prescriptions, exacerbating their already precarious reliance on opioids. Former employee accounts painted a grim picture of working conditions, where even healthcare professionals faced physical repercussions due to excessive injection practices, with one employee testifying that repetitive actions caused long-term injury to his hand.

During the trial, multiple former employees recounted their experiences under Kestner’s management, illustrating a high-pressure environment where financial motivations consistently overshadowed ethical concerns. As a result, both patients and providers fell victim to a system that profited from addiction rather than healing.

In sum, the Pain MD scandal serves as a stark reminder of the potential for abuse within the healthcare system, particularly when financial incentives overshadow patient care. As investigations continue and more individuals come forward with their stories, the ramifications of such systemic failures will likely resonate for years to come.

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