Fort Worth, Texas-based physician assistant Ray Shoulders, 36, and his conspirators submitted $788,000 in fraudulent claims and received more than $614,000 in reimbursements for injecting amniotic fluid to relieve pain, according to a Jan. 25 news release from the Justice Department.
Amniotic products have been approved by the FDA for wound care but not for pain management, thus they are not reimbursable by Medicare.
Initially, Mr. Shoulders asked patients to pay out of pocket more than $800 per injection, which they refused. He then identified another amniotic product he believed he could convince Medicare to reimburse; he continued to inject the original product into patients but billed under the second product’s new code to receive a higher reimbursement. Patients consented to the procedure because it was allegedly covered by insurance, the release said.
Mr. Shoulders faces up to 240 years in federal prison.
