Brett Kelman | Nashville Tennessean

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.

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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.

A day without sticking people is like a day without sunshine. MedManagement official email, per federal lawsuit

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.

In response to the federal lawsuit, an attorney for Pain MD and MedManagement said Friday that there was “no factual basis” of the allegation that the companies had intentionally mislabeled the injections.

Attorney Jay Bowen described the injections as medically necessary and insisted the federal government was allowing “bureaucrats and lawyers to second-guess medical decisions.”

“There is somewhat of a disconnect in the facts that the feds are saying these injections are medically necessary when we’ve been getting reimbursed for them continuously and getting reimbursed in other states,” Bowen said. “And if not for these therapies, these patients as typical chronic back pain sufferers would be lining up for opioids. This is an alternative to the much-criticized opioids treatments.”

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.

“These clinics put profit over patients,” said Attorney General Herbert Slatery last year. “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.”

According to both lawsuits, MedManagement is co-owned by Michael Kestner, a non-practicing attorney, and Dr. Lisabeth Williams, who is also the company’s chief medical officer. In addition to Pain MD, MedManagement currently manages or has previously managed the following pain clinics: Mid-South Pain Management, Cumberland Back Pain Clinic, Lebanon Back Pain Clinic, Blue Mountain Medical Group, Natural Bridge Medical Group and Rock Island Medical Group. Altogether, these companies amount to no less than 21 pain clinics spread throughout the American southeast.