I have often posted over the years, that forcing a pt to get ESI injections was a violation of part of the Sherman Antitrust Act, called Tying Commerce https://en.wikipedia.org/wiki/Tying_(commerce)
Basically, it is illegal to force someone to purchase something they don’t want in order to be able to buy something that they do want. Also, charging any insurance for products/services that is not medically necessary is considered INSURANCE FRAUD.
There are a couple of countries that have made it illegal to administer corticosteroids via ESI’s. Our FDA and Pfizer who is the pharma of the corticosteroids commoningly used DO NOT RECOMMEND corticosteroids being administered by ESI.
there is also a federal law that prohibits any inducement to a pt to cause Medicare/Medicaid to incur an expense. I guess that it was too much trouble for the DOJ… to pursue all the laws that were being violated.
Doctor admits health care fraud at pain management center
A former physician has pleaded guilty in federal court to a health care fraud charge associated with the pain management practice Jefferson Pain and Rehabilitation Center, the U.S. Attorney’s office in Pittsburgh announced.
John Keun Sang Lee, 79, of Peters, pleaded guilty Friday to one count of health care fraud before United States District Judge W. Scott Hardy.
In connection with the guilty plea, the court was advised that between in and around May 2016 to in and around October 2020, Lee submitted claims for steroid injections to Medicare and Medicaid that were neither reasonable nor medically necessary, a press release stated.
“According to former patients and employees, Lee required patients to submit to steroid injections, even when patients reported that the injections were not helping but rather causing them more pain and other injuries. Lee also instructed employees to withhold patient medication if patients objected to the injections. In order to justify billing insurance companies for the medically unnecessary injections, Lee directed staff to use templates indicating that patients received 80% relief from prior pain injections” the release said.
Judge Hardy scheduled sentencing for March 7, 2023.
As part of his plea agreement, Lee has agreed to pay $264,730 in restitution to the United States Department of Health & Human Services and $153,230 to the Pennsylvania Department of Human Services for losses associated with the fraudulent billings. Lee also has agreed to voluntarily surrender his medical license and DEA registration and not to maintain any ownership or management interest in any medical clinic or facility.
Filed under: General Problems
Glad to see something is done to physicians that FORCE patients into useless injections just to get an rx for opioids. I did get relief for the injections in my hip, but when it became bone on bone, they were useless. Did get a hip replacement. Had the injections in my spine – useless. My pain mgmt doc does require you try them before starting opioid therapy. I did, didn’t work, so she began opioid therapy for me. She’s good, but strict. I don’t do well in situations where I am constantly pee tested – causes unnecessary anxiety and stress. I don’t do street drugs and my pill counts are exact to the prescription. I worry about false positives, resulting in immediate removal of my life-giving low level opioid therapy. I don’t want to go back to life before opioids, so you better believe I do everything to “comply”. Gets my hackles up being pee tested all the freaking time, when it is clear I’m taking the meds as directed! Makes me so mad I can’t see straight. I’m a low risk patient that does not need that extra level of scrutiny.