PainMD and its parent company own or manage at least 30 pain clinics in three states.

Federal officials accuse PainMD of giving unnecessary injections to patients to maximize profits.

Now, interviews with a former patient and a PainMD insider back up those allegations.

Editors note: This story was updated on January 28 to reflect the filing of an additional lawsuit in the case.

As Lenny Quintavalla tells it, the pain clinic treated his back “like a dart board.”

Every two weeks, Quintavalla, a 57-year-old Navy veteran with severe spine problems, visited a pain clinic in Denver, North Carolina, where a doctor or a nurse practitioner required him to get about 20 injections into his back muscles before they would write him a prescription for pain medicine.

The injections brought Quintavalla some relief, but sometimes he wondered if he needed so many. Other patients did too. In the waiting room of the clinic, Quintavalla says he often overheard patients complaining about the numerous injections. Clinic staff insisted they were mandatory, he said.

“It was told to me when I first went in there that if I didn’t get the trigger point injections, there wouldn’t be any treatment at all,” Quintavalla said. “I was a little suspicious, but there were patients that I talked to in the waiting room who said the injections were not helping, they didn’t want them and they didn’t understand why they had to get them."

Quintavalla was one of about 4,500 patients of PainMD, a pain management company with clinics in Tennessee, North Carolina and Virginia that federal and state officials have accused of pressuring patients into unnecessary injections so it could defraud the government out of more than $10 million.

According to lawsuits filed by the federal government and the state of Tennessee, PainMD would require patients to receive multiple pain-relieving injections into their back at every visit, then intentionally mislabel the injections during billing so it could maximize profits from Medicare, Medicaid and Tricare.

PainMD has adamantly denied any wrongdoing in court and public statements.

2 injections, different reimbursements

The crux of the alleged scheme revolves around two pain-relieving injections that sound similar but are dramatically different when it comes to government insurance reimbursement. The lawsuits say that PainMD staff gave patients “trigger point injections,” an injection into a back muscle that government insurance programs will generally cover about four times a year, but intentionally mislabeled these injections as “tendon origin injections," a more specific procedure for which the government does not cap coverage.

The end result of the scheme, as alleged in court records, is that PainMD got rich, taxpayers got screwed and patients got jabbed with a needle over and over for no justifiable reason at all.

“Now, seeing the injections were being forced upon people, it makes a lot of sense,” Quintavalla said. “It’s exactly what people used to tell me in the waiting room."

Jay Bowen, an attorney for PainMD, said Tuesday that company management could not have swapped injections in the billing process because billing documents were sent directly from pain clinics to a third-party company.

Bowen also said it was “unequivocally" untrue that PainMD mandated injections for all patients or intentionally mislabeled any of the injections.

But he stressed that injections were core to the “interventional” strategy of PainMD, which prides itself on using alternative treatments to lessen the need for opioids. Often, but not always, these alternatives took the form of injections, Bowen said.

“These are interventional clinics, so that’s what they offer,” Bowen said. “If you don’t want to consider acupuncture, don’t go to an acupuncture clinic. If you don’t want to buy shoes, don’t go to a shoe store.”

Despite the strong denial of PainMD, the allegations presented in federal and state lawsuits are backed by the statements of Cathleen Lanigan, an ex-employee who spoke publicly about operations at the clinic in an interview with The Tennessean.

Lanigan, a certified medical assistant who worked at a North Carolina clinic for nine months in 2017, said a manager threatened her after she stumbled upon injection billing discrepancies. Lanigan also said PainMD set a $300 billing quota for every patient visit and employees were encouraged to use repeated injections to meet the quota.

Bowen dismissed the accounts of Quintavalla and Lanigan, describing them as a bitter ex-patient and a disgruntled former employee, respectively. Bowen said Quintavalla was cut from the clinic over allegations of doctor shopping and that Lanigan was fired for "failure to come to work."

In response, Quintavalla said PainMD falsely accused him of doctor shopping after he switched insurance carriers. Lanigan said she "took a leave for mental clarity" after discovering the company's scheme, then was terminated while away from the clinic.

After this story published, PainMD filed a defamation lawsuit against both Quintavalla and Lanigan, accusing them of making “defamatory and demonstrably untrue” statements about the company in this article.

“These allegations are false.,” Kestner said in a statement announcing the lawsuit. “Our nurses, doctors, and other healthcare professionals are passionate about our patients’ health and well-being, and ensure that our patients get the care and support they need.”

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Pain clinics in 3 states

PainMD and its parent company, MedManagement, own or manage at least 30 pain clinics in Tennessee, Virginia and North Carolina, some of which operate under the umbrella of Mid-South Pain Management, according to federal court records. All three companies are headquartered in Franklin and are owned or operated by a partnership of Dr. Lisabeth Williams and Michael Kestner, a non-practicing attorney.

Bowen, the company attorney, denied the companies had owned or managed 30 clinics, but said he was unsure how many clinics were part of their organization.

Lanigan said Kestner held a daily video conference call with the staff at the North Carolina clinic to verify that every patient appointment would amount to a bill of at least $300. Lanigan said Kestner’s business model was clear: If a bill did not amount to $300, do more injections until it did.

“He didn’t know our patients. He didn’t know what treatment they had in the past. He didn’t know what their chief complaint was,” Lanigan said. “But he knew if their visit wasn’t costing $300.”

As a medical assistant, Lanigan didn’t give patients the injections directly, but she was responsible for getting patients to sign paperwork consenting to them. Every patient was required to sign before they were seen by a medical practitioner or diagnosed with any condition, Lanigan said.

If they didn’t sign, they were sent away.

“For some patients (the injections) didn’t work or only lasted a short time and the pain they were going through to get them was worse than the pain they were treating,” Lanigan said. “A lot of them got really upset. Some of them were making comments like ‘You are just doing it for the money.' "

Bowen, the PainMD attorney, said the clinics never set profit quotas for patient appointments, but stressed that the company was a business that had to be cognizant of its finances.

He added that some patient complaints likely came from drug seekers.

"I’m am sure there are former patients who are frustrated because they couldn’t just show up, get pills and leave,” Bowen said.

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'It's none of your business'

Lanigan said the full extent of the alleged injection scheme became too obvious to overlook in the fall of 2017 when a patient insisted there was an error in the bill to her insurance.

The bill said the patient had been given a tendon injection, but the patient — a former nurse — knew she had received a trigger point injection instead.

At first, Lanigan assumed it was an honest mistake, she said. She double-checked the patient’s medical records, then dialed a PainMD manager in Tennessee to alert him to what she presumed was a billing error.

Before she even said the patient’s name, the manager shut down the call, Lanigan said.

“It’s none of your business,” the manager said, according to Lanigan. “If I ever find out you are doing this again, you will be reprimanded.”

He hung up. Lanigan looked at the patient, unsure what to say.

“She saw the look on my face, and I think she knew,” Lanigan said. “That was when I knew for sure that something was wrong.”

Bowen said Tuesday that this phone conversation could not have occurred as Lanigan described because PainMD has never employed a male manager in its billing department. However, Facebook posts show that PainMD employs at least one male business performance manager.

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Brett Kelman is the health care reporter for The Tennessean. He can be reached at 615-259-8287 or at brett.kelman@tennessean.com. Follow him on Twitter at @brettkelman.