Fort Worth physician’s assistant convicted of health care fraud in pain relief scheme

Fort Worth Star-Telegram (TX)

A Fort Worth physician’s assistant was convicted on health care fraud charges after authorities say he injected unapproved amniotic fluid into patients’ joints for pain management, federal prosecutors said.

After only about an hour of deliberation Monday, a jury convicted Ray Anthony Shoulders, 36, of conspiracy to commit health care fraud and 12 counts of health care fraud. He was a physician’s assistant at a Fort Worth pain management clinic, according to a Thursday news release from U.S. Attorney for the Northern District Leigha Simonton.

He will be sentenced at a later date.

“Not only did this defendant attempt to scam Medicare out of hundreds of thousands of dollars, he did something far worse by potentially endangering his patients’ health in recommending that they be injected with a drug that had not been approved for that purpose,” Simonton said in the release.

Shoulders and co-conspirators submitted $788,000 worth of fraudulent claims and received more than $614,000 in reimbursements from Medicare for injecting amniotic fluid into patients’ connective tissues to relieve joint pain, according to evidence presented at trial. Amniotic fluid is the liquid that surrounds a growing fetus during gestation, the release states.

Certain amniotic products have been approved by the U.S. Food and Drug Administration for wound care, but not for pain management, according to the release. Because amniotic fluid injections have not been approved to treat pain, Medicare does not reimburse for those.

Shoulders used a product, “Cell Genuity,” which is not reimbursed or covered by Medicare. Because the product was not covered by insurance, the defendant asked patients to pay more than $800 out of pocket per injection.

Many patients refused due to high cost and “questionable efficacy,” the release said.

In August 2020, Shoulders identified an amniotic product, “Fluid Flow,” that he believed he could convince Medicare to reimburse, according to the release. He also spoke with a sales rep about Fluid Flow reimbursement rates and billing, but did not make any purchases. Fluid Flow was significantly more expensive than Cell Genuity, the release says.

Shoulders continued injecting Cell Genuity products into patients but billed the shots to Medicare under Fluid Flow’s code. Because patients were told insurance would cover the costs of the injections, they consented to the procedure, according to the release.

From August to October 2020, the clinic submitted more than 100 bills for Fluid Flow to Medicare and received about $400,000 in reimbursements. Shoulders received a cut of those reimbursements, totaling $200,000, according to the release.

In November 2020, in an attempt to avoid attention, Shoulders put a halt to the scheme after becoming concerned about a sudden increase in the volume of billings that would attract investigators.

But he re-engaged in the scheme from October to December 2021, according to the news release.

Shoulders faces up to 240 years in prison, authorities said.