DENVER – The parent company of a now-closed Denver pain clinic is embroiled in a federal False Claims Act lawsuit filed in November.
PainMD and its management company, MedManagement Inc. (MMI) – both of which are based in Franklin, Tenn. – are alleged to have knowingly and routinely submitted false claims to Medicare and Tricare, a health care program for military veterans.
According to the lawsuit, MMI is owned and operated by Michael Kestner, a non-practicing attorney with no medical training, while Lisabeth Williams is the chief medical officer and minority owner of PainMD. In addition to PainMD, MMI managed six similar companies with clinics throughout North Carolina, Tennessee and Virginia.
The federal government alleges that from at least 2010 through October 2018, Kestner and Williams conspired to fraudulently bill Medicare and Tricare for tendon origin or insertion injections (TOI), which are pain-relieving injections commonly used to treat tendon-related conditions like tendonitis, with no limit to the allowable number billed through Medicare or Tricare.
The lawsuit, however, states that patients of the clinics weren’t receiving injections into their tendons at all, but rather six to 12 injections into their back muscles per visit, which were then billed as TOIs. The other injections, known as triggerpoint injections, are limited to four billings per year through Medicare and Tricare.
From June 1, 2010 to Dec. 31, 2015, Medicare paid the pain clinics approximately $3 million for the alleged fraudulent claims, according to the lawsuit.
From March 6, 2014 to Oct. 18, 2018, the Tricare program paid PainMD approximately $288,000 for the alleged fraudulent claims.
Attorney Jay Bowen, who’s representing MMI and PainMD in the legal proceedings, has denied allegations that his clients intentionally mislabeled the injections