Each month, Michelle Shaw visited a pain clinic, navigating a troubling cycle where the injections she received only exacerbated her discomfort, but were required to obtain the prescriptions that alleviated her pain. At 56, Shaw has been reliant on opioid painkillers since injuring her back in a fall a decade prior. In interviews and sworn testimony, she detailed how the Tennessee clinic would only write her prescriptions if she consented to endure three or four painful injections of another medication along her spine.
The clinic claimed these were steroid injections meant to reduce her pain; however, Shaw testified that each shot seemed to make her condition worse. Eventually, when she attempted to refuse the injections, the clinic threatened to cut off her access to painkillers unless she complied.
“I had nowhere else to go at the time,” Shaw recounted in federal court, stating she felt trapped in this distressing situation.
Shaw’s experiences are part of a broader pattern that involved thousands of patients at Pain MD, a multistate pain management company notorious for its extensive use of what it labeled as “tendon origin injections.” These injections were paired with opioid prescriptions at a time when many doctors were hesitant to prescribe opioids due to the ongoing crisis. Pain MD insisted that the injections could not only relieve pain but potentially reduce patients’ dependence on painkillers, according to federal court documents.
Shaw served as a significant witness in the trial of Pain MD president Michael Kestner, who was convicted of multiple felonies related to healthcare fraud in October. Testifying in court, she described how during her visits to Pain MD, she would sometimes arrive with a cane but leave in a wheelchair, left battered by the additional pain from the injections. “That was the pain clinic that was supposed to be helping me,” she said, highlighting her despair at feeling exploited.
Not Just Tendon Injections
Pain MD, which sometimes operated under the name Mid-South Pain Management, ran numerous clinics across Tennessee, Virginia, and North Carolina during the 2010s. Some of these establishments recorded an average of 12 injections per patient each month, with certain patients receiving as many as 24 shots during a single visit. Court documents indicate a staggering 700,000 injections were documented over eight years.
The Department of Justice has argued that these injections—deemed “unnecessary and expensive”—were largely ineffective. Evidence showed that they often targeted the wrong area and did not contain the promised steroids, relying instead on numbing agents that provided temporary relief. These injections were largely based on tests performed on deceased individuals for whom the efficacy of pain relief was irrelevant.
Four employees of Pain MD have either pleaded guilty to or been convicted of health care fraud, including Kestner. Testimony at Kestner’s trial revealed that the clinic billed Medicare for over 290,000 of these injections from early 2010 to mid-2018, far exceeding the totals billed by other healthcare providers during that time frame. The company collected millions from government and private insurers for these procedures, even as many patients questioned their necessity.
Healthcare fraud cases like this are not isolated, as pointed out by former U.S. attorney Don Cochran. The systematic overbilling for services, sometimes involving legitimate treatments abusively, often emerges in various corners of the healthcare system. The Pain MD case, however, stands out due to the manipulation of patients’ opioid dependencies. Those reliant on opioids were less likely to challenge the dubious treatment they received, leading some to describe the scheme as particularly nefarious.
The allegations against Pain MD surfaced publicly in 2018 after federal authorities filed a civil lawsuit against the company and its higher-ups, accusing them of defrauding government healthcare programs through the false billing of ineffective injections. Kestner and his associates have denied the allegations, and the lawsuit remains ongoing.
Experts have testified that legitimate tendon origin injections are typically directed at inflamed joints and require only minimal application. However, Pain MD’s procedures frequently misused these medical practices, employing needles that were inadequate for their intended purpose and lacking necessary imaging technology to guide treatments. Testimony indicated that the scale of their billing was not only improper but also bordered on absurdity, raising questions about the legitimacy of their entire operation.
In Shaw’s case, the pain clinic she turned to for relief ended up compounding her suffering, leaving her feeling used and trapped in a system that prioritized profit over the well-being of its patients.
