The National Consumer Protection Technical Resource Center: The Center of Service & Information for SMPs

Health Care Fraud

From the Office of Inspector General (OIG), U.S. Department of Health & Human Services

Pain Management Clinics

Pain management clinics specialize in several methods of treating chronic pain patients. This may involve therapy, injections, implantable devices or oral pain medications. Most legitimate pain clinics have a clinician who is trained or certified in the treatment of chronic pain. However, now multiple fraudulent pain management clinics have sprung up all across the country and in some areas have become a tremendous problem.

How the Scam Works

  • Pain management clinics will recruit Medicare beneficiaries in a nearby neighborhood and provide van transportation to clinics to treat their “pain.” Once there, the beneficiary will typically receive the following unwarranted and unnecessary services: a consultation by a chiropractor, physical therapy, back adjustments by a chiropractor, injections by a physician or physician assistant and oftentimes x-rays.
  • Sometimes these fraudulent pain clinics will bill for a traction device called a Vax-D, which is not paid for under Medicare rules. In addition, Medicare beneficiaries will receive trigger point injections in their backs, but Medicare will get billed for a much more expensive procedure called a facet injection. After all this fraudulent therapy, the “patient” is taken by van again, treated to lunch and driven home. The whole process begins again in a few days, and the fraudulent billing continues.

How to Fight Back

  • Be careful in accepting medical services that are proactively offered by a health care professional you do not know.
  • If someone comes to your door and says he is from Medicare or some other health care company simply shut the door.
  • Be suspicious if you are told that Medicare wants you to have this item or service and claim that, “We know how to get Medicare to pay for it.”

Report Suspected Fraud

To report suspected fraud, click here.

 

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