Pain Management Physician’s Assistant Charged in Amniotic Fluid Scam

A pain management physician's assistant faces charges in an amniotic fluid scam, injecting patients' joints under false pretenses. The scheme resulted in over half a million dollars being scammed from Medicare. The case underscores the importance of combating healthcare fraud to protect patients and maintain accountability.

In a shocking case of healthcare fraud, a pain management physician’s assistant has been charged with injecting amniotic fluid into patients’ joints as a questionable method of pain management. Ray Anthony Shoulders, a 36-year-old physician’s assistant at a Fort Worth clinic, was indicted on charges of conspiracy to commit healthcare fraud and healthcare fraud. Shoulders allegedly claimed that the unapproved treatment was covered by Medicare, giving false hope to patients suffering from chronic pain. This fraudulent scheme resulted in Medicare being scammed out of over half a million dollars. The Northern District of Texas is determined to combat healthcare fraud and ensure the safety of patients by holding medical professionals accountable for their actions.

Physician’s Assistant Charged in Amniotic Fluid Scam

A physician’s assistant at a Fort Worth pain management clinic has been charged with healthcare fraud for his alleged involvement in an amniotic fluid scam. Ray Anthony Shoulders, 36, was indicted on one count of conspiracy to commit healthcare fraud and eleven counts of healthcare fraud. The charges stem from his purported injection of amniotic fluid into patients’ joints in an attempt to alleviate pain. These actions were not approved by the U.S. Food and Drug Administration (FDA) and Medicare, and Shoulders is accused of defrauding Medicare out of over half a million dollars.

Charges and Indictment

Shoulders has been charged with healthcare fraud, specifically one count of conspiracy to commit healthcare fraud and eleven counts of healthcare fraud. These charges were brought against him by the U.S. Attorney for the Northern District of Texas, Leigha Simonton. Shoulders made his initial appearance before U.S. Magistrate Judge Jeffrey Cureton.

Alleged Scam and False Claims

Shoulders’s alleged scam involved injecting amniotic fluid into patients’ joints under the false pretense that it would alleviate their pain. He reportedly told patients that the treatment was covered by Medicare, giving them false hopes. In reality, the use of amniotic fluid for pain management has never been approved by the FDA. Furthermore, Medicare considers amniotic injections for pain to be medically unnecessary and does not reimburse for them.

Amniotic Fluid’s Approval for Wound Care, Not Pain Management

While certain amniotic products have been approved by the FDA for wound care, they have not been approved for pain management. The FDA has issued consumer alerts warning against using amniotic fluid for treating orthopedic conditions, chronic pain, or fatigue. Medicare’s reimbursement policies reflect this, as they only reimburse for amniotic injections administered to reduce inflammation in damaged tissue, such as in wound care.

Medicare Reimbursement Policies

Medicare considers amniotic injections for pain to be medically unnecessary and, therefore, does not provide reimbursement for them. The reimbursement policy is based on the FDA’s approval and classification of medical treatments. Since amniotic fluid has not been approved for pain management, Medicare does not cover its use in this context. It is essential for healthcare providers to adhere to these policies to avoid potential healthcare fraud charges.

Use of ‘Cell Genuity’ and ‘Fluid Flow’ Products

Shoulders allegedly used “Cell Genuity,” an amniotic product for which Medicare does not provide reimbursement. Initially, he asked patients to pay out of pocket for the injections, which cost over $800 per injection. However, due to the high cost and questionable efficacy of Cell Genuity, many patients declined the treatment. In August 2020, Shoulders allegedly found another amniotic product called “Fluid Flow,” which Medicare would reimburse for when used in wound care. Although Fluid Flow was significantly more expensive than Cell Genuity, Shoulders continued to inject the latter into patients but billed the shots to Medicare using Fluid Flow’s unique code, Q4206.

Billing Medicare under the Wrong Code

By using Fluid Flow’s reimbursement code while actually administering Cell Genuity to patients, Shoulders allegedly deceived Medicare into providing reimbursement for the treatment. This allowed the pain clinic to profit significantly from each injection since they would receive approximately $1,200 per cc of Cell Genuity injected, compared to only around $400 per cc if they had used Fluid Flow. To further amplify their profit margins, the clinic increased the number of patients consenting to the procedure by falsely informing them that insurance would cover the cost of the injections.

Profit Margins and Clinic’s Benefit

The comparison between Cell Genuity and Fluid Flow profit margins highlights the clinic’s financial gain in the scam. The use of Cell Genuity, despite it being a non-reimbursable product, allowed the clinic to maximize its profit, receiving $1,200 per cc of the product injected. If they had used Fluid Flow, the profit per cc would have been significantly lower at around $400. This stark difference demonstrates the clinic’s motivation to engage in the fraudulent scheme.

Temporary Halt and Resumption of Scheme

In an attempt to avoid detection, Shoulders temporarily halted the fraudulent scheme in November 2020 after noticing a sudden increase in billings that could attract attention from investigators. However, with no consequences for the initial fraudulent activities, Shoulders allegedly resumed the scheme in October 2021 and continued until December 2021. During this period, he purchased 10ccs of Fluid Flow for $20,000, the only recorded purchase of Fluid Flow by the clinic. Nonetheless, Shoulders still billed Medicare for approximately 394ccs of Fluid Flow, falsely claiming to have administered it to patients.

Potential Consequences for Shoulders

If Shoulders is convicted on all counts, he could face up to 120 years in federal prison, with each count carrying a maximum sentence of 10 years. These charges and potential consequences highlight the severity of healthcare fraud and the need for enforcement to protect patients and the integrity of healthcare systems.

Investigation and Prosecution

The investigation into Shoulders’ alleged scam was conducted by the Department of Health & Human Services’ Office of Inspector General (HHS-OIG) with assistance from the Federal Bureau of Investigation’s Dallas Field Office. The case is being prosecuted by Assistant U.S. Attorney P.J. Meitl. The involvement of federal agencies in investigating and prosecuting healthcare fraud emphasizes the commitment to eradicating such fraudulent activities and holding perpetrators accountable.