Health Care Fraud: Michael Kestner And Lisabeth Smolenski Convicted For False Claims To Medicare And TRICARE

<h2>United States Files Suit Against Franklin&comma; Tennessee-Based Pain&comma; MD&comma; LLC and Related Pain Clinics and Owners<&sol;h2>&NewLine;<p><strong>Lawsuit Alleges False Claims Act Conduct at Pain Management Clinics in Tennessee&comma; North Carolina and Virginia<&sol;strong><&sol;p>&NewLine;<div class&equals;"mh-content-ad"><script async src&equals;"https&colon;&sol;&sol;pagead2&period;googlesyndication&period;com&sol;pagead&sol;js&sol;adsbygoogle&period;js&quest;client&equals;ca-pub-9162800720558968"&NewLine; crossorigin&equals;"anonymous"><&sol;script>&NewLine;<ins class&equals;"adsbygoogle"&NewLine; style&equals;"display&colon;block&semi; text-align&colon;center&semi;"&NewLine; data-ad-layout&equals;"in-article"&NewLine; data-ad-format&equals;"fluid"&NewLine; data-ad-client&equals;"ca-pub-9162800720558968"&NewLine; data-ad-slot&equals;"1081854981"><&sol;ins>&NewLine;<script>&NewLine; &lpar;adsbygoogle &equals; window&period;adsbygoogle &vert;&vert; &lbrack;&rsqb;&rpar;&period;push&lpar;&lbrace;&rcub;&rpar;&semi;&NewLine;<&sol;script><&sol;div>&NewLine;<p>NASHVILLE&comma; Tenn&period; – November 16&comma; 2018 –U&period;S&period; Attorney Don Cochran for the Middle District of Tennessee announced today that the United States has filed a False Claims Act lawsuit against Franklin&comma; Tennessee-based Pain&comma; MD&comma; LLC and related companies&comma; and their owners Michael Kestner and Lisabeth Smolenski Williams&period; The lawsuit alleges that the defendants knowingly and routinely submitted&comma; or caused to be submitted&comma; false claims to Medicare and TRICARE for single tendon origin or insertion injections &lpar;&OpenCurlyDoubleQuote;TOI”&rpar; that they knew or should have known were not provided to patients&period; TOI injections are pain-relieving injections commonly used to treat such tendon related conditions as tendonitis and are not limited by Medicare or TRICARE as to the allowable number billed&period; In contrast&comma; other treatments&comma; such as trigger point injections are limited to four per year&period;<&sol;p>&NewLine;<p>According to the complaint&comma; Michael Kestner is a non-practicing attorney with no medical training&comma; who owns&comma; operates and controls MedManagement&comma; Inc&period; &lpar;&OpenCurlyDoubleQuote;MMI”&rpar;&comma; a management company located in Franklin&comma; Tennessee&period; Lisabeth Williams is a physician and the Chief Medical Officer and minority owner of Pain&comma; MD&period; She also served as a supervising physician or medical director for the pain clinics at certain times&comma; with oversight for provision of all of the medical care and services provided by the pain clinics to their patients&period; MMI manages and has managed Pain&comma; MD&comma; Mid-South Pain Management&comma; P&period;C&period;&semi; Cumberland Back Pain Clinic&comma; P&period;C&period;&semi; Lebanon Back Pain Clinic&comma; P&period;C&period;&semi; Blue Mountain Medical Group&comma; P&period;C&period;&semi; Natural Bridge Medical Group&comma; P&period;C&period;&semi; and Rock Island Medical Group&comma; P&period;C&period;<&sol;p>&NewLine;<p>The United States alleges that from at least 2010 through October 2018&comma; Kestner and Williams devised a scheme to operate interventional pain management clinics in Tennessee&comma; North Carolina and Virginia&comma; and fraudulently bill Medicare and TRICARE for TOI injections that were not actually injections into tendons at all&period; Through this scheme&comma; Kestner and Williams recruited providers&comma; including mid-level medical providers such as nurse practitioners and physician’s assistants&comma; to the pain clinics and trained&comma; pressured&comma; and coerced them into performing high numbers of injections into patients’ back muscles&comma; and then bill for these injections as if they were TOIs&period; The corporate pressure to meet the targeted goal of being within 15&percnt; of the top-biller of TOIs resulted in the pain clinic providers routinely giving patients six to eight injections per visit and sometimes as many as 12 injections into the back muscles&comma; which were then billed as TOIs&period; During parts of the time period alleged in the lawsuit&comma; patients were required to submit to the injections as a condition of treatment and remaining a patient of the practice&period; As a direct result of these practices&comma; the defendants&comma; either directly or indirectly&comma; submitted false claims to Medicare and TRICARE and received millions of dollars in reimbursement from federal health care programs to which they were not entitled&period;<&sol;p>&NewLine;<p>For the period from June 1&comma; 2010 through December 31&comma; 2015&comma; the Medicare program paid the defendant pain clinics approximately &dollar;3 million for fraudulent services billed for Medicare beneficiaries treated at the clinics&period; For the period from March 6&comma; 2014 through October 18&comma; 2018&comma; the TRICARE program paid Pain&comma; MD approximately &dollar;288&comma;000 for fraudulent services billed for TRICARE beneficiaries treated at clinics under their control&period;<&sol;p>&NewLine;<p>Congress established the Medicare Program in 1965 to provide health insurance coverage for people age 65 or older and for people with certain disabilities or afflictions&period; Medicare Part B covers services like doctors’ and nurse practitioners’ visits and medical supplies&period; TRICARE &lpar;formerly known as CHAMPUS&rpar; is a federal health care program that provides health care insurance for active duty <a class&equals;"wpil&lowbar;keyword&lowbar;link" href&equals;"https&colon;&sol;&sol;www&period;fraudswatch&period;com&sol;category&sol;military-scammer&sol;amp&sol;" title&equals;"military" data-wpil-keyword-link&equals;"linked" data-wpil-monitor-id&equals;"396">military<&sol;a> personnel&comma; military retirees&comma; and military dependents&period;<&sol;p>&NewLine;<p>The case is docketed as United States v&period; Michael Kestner&comma; et al&period; &lpar;M&period;D&period; Tenn&period;&rpar;&period; Assistant U&period;S&period; Attorney Ellen Bowden McIntyre represents the United States&period; Investigative support is provided by the Office of Inspector General of the U&period;S&period; Department of Health and Human Services and the Tennessee Bureau of Investigation&period; The claims in the complaint are allegations only&comma; and there has been no determination of liability&period;<&sol;p>&NewLine;<p><a href&equals;"https&colon;&sol;&sol;www&period;justice&period;gov&sol;usao-mdtn&sol;pr&sol;united-states-files-suit-against-franklin-tennessee-based-pain-md-llc-and-related-pain">Original PressReleases&&num;8230&semi;<&sol;a><&sol;p>&NewLine;

Health Care Fraud