Court evidence revealed that Kestner, who is not a licensed physician, pressured nurse practitioners and physician assistants within his clinics in Tennessee, North Carolina, and Virginia to administer multiple back injections to patients seeking opioid treatment.
A federal jury has convicted Michael Kestner, a 72-year-old business owner from Nashville, for defrauding federal health care programs out of approximately $35 million. The scheme involved billing for medically unnecessary injections given to opioid-dependent patients over eight years at his pain clinics, branded as Pain MD.
Court evidence revealed that Kestner, who is not a licensed physician, pressured nurse practitioners and physician assistants within his clinics in Tennessee, North Carolina, and Virginia to administer multiple back injections to patients seeking opioid treatment. Testimony indicated that patients who refused these injections risked being denied care and facing withdrawal symptoms from their medications.
Kestner’s clinics routinely billed for Tendon Origin Insertion (TOI) injections, despite almost none of the patients being diagnosed with tendon pain. In many instances, it was medically impossible to perform these procedures with the available equipment. Kestner exerted significant pressure on his staff, frequently sending emails that ranked their “production” and criticized those who fell short of his expectations, fostering a toxic work environment where providers felt they could lose their jobs if they didn’t comply.
The prosecution presented evidence that Kestner ignored multiple warnings, including lawsuits from insurance companies, about the improper billing practices. As a result, Pain MD became the highest biller of TOI procedures for Medicare in the country, billing eight times more than the next highest clinic.
Kestner was convicted on one count of conspiracy to commit health care fraud and 12 counts of health care fraud. He is scheduled to be sentenced on February 27, 2025, and could face up to 10 years in prison for each count. A federal judge will determine his sentence based on the U.S. Sentencing Guidelines and other relevant factors.
