BOSTON - A New York man was convicted today in federal court for committing health care fraud.
Michael J. McKay, 32, of Saratoga Springs, NY, pleaded guilty before U.S. District Judge Denise J. Casper to committing health care fraud.
Had the case proceeded to trial the Government’s evidence would have proven that between 2008 and 2009 McKay was a territory manager for a company that manufactured and distributed bone growth stimulator medical devices. McKay’s territory included New York, Pennsylvania and Ohio. The device that McKay sold was intended to assist patients with bone fractures that did not heal properly. Medicare has specific guidelines describing when it will pay for this device for one of its beneficiaries. Many private insurance carriers follow these guidelines as well. McKay often received orders for patients that did not satisfy these guidelines. When this happened, McKay forged the patients’ medical records to make it appear as though the order met Medicare’s guidelines to induce Medicare (or the private carrier) to pay for claims that otherwise would not be covered. For instance, McKay altered physician’s chart notes, changing the dates of patient visits and inserting false diagnoses.
McKay also created phony medical chart notes, describing patient visits that did not occur. The medical device company fired McKay after it discovered his fraud. Thereafter, McKay’s supervisor and another territory manager, Derrick Field, concocted a scheme in which McKay continued to submit orders from doctors in his former territory, but he submitted them through Field. Field, who was also convicted for health care fraud in a similar scheme, submitted the orders to the device company and split the commissions with McKay. McKay continued to forge patients’ medical records even after he was fired by the company for this conduct. Between 2008 and 2010, federal insurance carriers paid more than $70,000 for bone growth stimulators where McKay forged the medical records.
Judge Casper scheduled sentencing for Sept. 6, 2012. McKay faces up to 10 years in prison to be followed by three years of supervised release a $250,000 fine, asset forfeiture and restitution.
United States Attorney Carmen M. Ortiz; Susan J. Waddell, Special Agent in Charge of the Department of Health and Human Services, Office of Inspector General; and Leigh-Alistair Barzey, Resident Agent in Charge of the Defense Criminal Investigative Service made the announcement today. The case is being prosecuted by Assistant U.S. Attorneys David Schumacher and Jeremy Sternberg of Ortiz’s Health Care Fraud Unit.