Feds: Pain clinics forced unnecessary injections on patients to make millions – by Brett Kelman, Nashville Tennessean – Nov 2018
This is the nightmare scenario that was mentioned in my previous post: Epidural Steroid Injections: Danger Worth the Benefits?
Federal prosecutors have accused a chain of pain clinics spread through Tennessee, North Carolina and Virginia of duping the government and the military out of millions of dollars by forcing patients to receive unnecessary injections into their back, then intentionally mislabeling the injections during billing.
The allegations are spelled out in a lawsuit filed Friday against Pain MD clinics and parent company MedManagement, or MMi, both of which are headquartered in Franklin, Tenn.
In the suit, prosecutors allege that the MMi company culture pressured medical staff to inject patients as often in as possible in an effort to inflate profits.
If patients wanted treatment, clinics required them to agree to six to 12 injections per visit, regardless of need, according to the lawsuit.
“A day without sticking people is like a day without sunshine,” one company official wrote in an internal email, according to the lawsuit.
The crux of the alleged scheme revolves around a pain-relieving medical procedure called “tendon origin injections,” or TOIs, which inject medication directly into the tendon to treat conditions like tendonitis. Medicaid and Tricare, which are federal health insurance programs, will cover an unlimited number of these injections for patients.
However, the new lawsuit accuses MedManagement of performing a more general procedure – a “trigger point injection,” or TPI – which injects medicine into a back muscle instead of a tendon, then intentionally mis-labeling the procedure as tendon injections in billing records.
Medicaid and Tricare limit TPI coverage to only four per year, so the company was able to greatly inflate its profits by pretending it was injecting into tendons, the lawsuit states.
Overall, the company duped Medicare out of approximately $3 million between 2010 and 2015, the lawsuit alleges. It also duped Tricare, which covers military personnel, out of another $288,000.
If the allegations sound familiar, they should.
Last year, state officials accused MedManagement of the same scheme in a lawsuit of their own, saying the company submitted about $7 million in fraudulent claims to TennCare over an 11-year span.
So, they are “repeat offenders” who were allowed to continue operations after the first crime and then proceeded to operate a new crime scheme. It looks like they are entirely “typical criminals” with a high rate of recidivism.
“These clinics put profit over patients,” said Attorney General Herbert Slatery last year.
This should not surprise anyone when our whole healthcare system is run by private companies that believe it’s “moral requirement” to seek the highest possible profit.
“Even more disturbing than the millions of dollars in fraudulent claims to the state is their lack of compassion for those coming to them for treatment.”
Now, this is a ridiculous statement. When our corporate culture has, by design, no goal or obligation except profit, “compassion” is a meaningless concept.
We are not paying for “care and compassion” when we are treated by a corporate medical practice. We are only contracting for whatever the corporation considers a “standard service”, nothing more.