Each month, Michelle Shaw visited a pain clinic to receive injections that exacerbated her back pain, all in a bid to secure the opioid prescriptions that provided her relief. Shaw, a 56-year-old who has relied on opioid painkillers since a fall injured her back a decade ago, recounted in interviews with KFF Health News and during court testimony that her Tennessee clinic mandated multiple painful injections before they would prescribe her pain medication.
Shaw stated that the clinic claimed these injections—allegedly steroid-based—would alleviate her suffering, yet each treatment only intensified her pain. When she attempted to refuse the injections, the clinic issued an ultimatum: either undergo the injections or find another source for her medications. “I had nowhere else to go at the time. I was stuck,” Shaw recounted in federal court.
Shaw was among the many patients caught in the web of Pain MD, a multi-state pain management company that became notorious for overutilizing what were referred to as “tendon origin injections.” As the opioid crisis led many physicians to curb their use of painkillers, Pain MD began coupling opioid prescriptions with monthly spinal injections, asserting that these shots would alleviate pain and reduce dependence on medications, as detailed in federal court documents.
In a landmark trial, Shaw emerged as a critical witness against Pain MD president Michael Kestner, who was convicted of multiple felonies tied to healthcare fraud. Years later, court proceedings revealed that Pain MD’s injection practices were part of a fraudulent scheme, resulting in millions made by exploiting patients’ vulnerabilities related to opioid dependence. The Department of Justice argued successfully that the injections—deemed unnecessary and costly—ineffectively targeted the wrong body parts, used short-acting numbing agents without steroids, and were based on tests administered to deceased patients, who experienced neither relief nor pain.
Four employees of Pain MD have either pleaded guilty or been convicted of health care fraud, including Michael Kestner, who faces a sentencing date set for April 21 in Nashville. Court transcripts disclose that during the trial, former patients like Shaw testified that the injections provided no relief and sometimes heightened their discomfort. Many patients endured these shots solely to maintain their access to opioid prescriptions, fearing withdrawal without them.
Patricia McNeil, another former patient, shared a similar experience in her testimony, asserting that she accepted the injections only to ensure she received her medications. Shaw, in a detailed interview, expressed her frustration: she would arrive at the clinic using a cane but leave in a wheelchair due to the injections’ aftermath. “It just felt like they were using me,” Shaw lamented.
**Fraudulent Practices Uncovered**
Pain MD operated under different names, including Mid-South Pain Management, for many years, running up to 20 facilities across Tennessee, Virginia, and North Carolina. Some clinics reportedly administered an average of 12 injections monthly per patient, with certain individuals receiving over 500 injections cumulatively, as disclosed in federal court documentation.
The financial repercussions of Pain MD’s practices were staggering. Medicare data revealed that Pain MD billed for more than 290,000 tendon origin injections between January 2010 and May 2018, outstripping any other Medicare provider in the U.S. by a significant margin. An audit from BlueCross BlueShield of Tennessee indicated that Pain MD billed approximately $40 million for over 380,000 injections from January 2010 to March 2013, with roughly $7 million paid out before the company was cut off.
Healthcare fraud cases of this nature are not uncommon, as opportunistic providers exploit legitimate treatments for illegal gains. This particular scheme raised eyebrows due to the intertwining of opioid prescriptions with fraudulent injections, creating a cycle of dependency among patients. “A scheme where you get Medicare or Medicaid money to provide a medically unnecessary treatment is always going to be out there,” said Don Cochran, a former U.S. attorney.
The allegations against Pain MD first surfaced in 2018 when the Department of Justice filed a lawsuit against the company and Kestner, asserting that the injections were not legitimate tendon treatments, a claim the defendants denied throughout the ongoing litigation.
Dr. Scott Kreiner, a spine care and pain medicine expert, testified that true tendon origin injections are generally used for inflamed joints and typically require only a single administration. The frequent and excessive injections by Pain MD contained only anesthetics, such as lidocaine or Marcaine, delivering temporary numbness but lacking therapeutic effectiveness. Kreiner stressed that the sheer volume of injections observed in the practice’s records was unfathomable in terms of medical necessity.
