Filling the Gap

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Calculator and stethoscope on paperwork

Telehealth allowed the healthcare industry to remain open during the COVID-19 pandemic. When many were opposed to venturing out to the doctor, telehealth filled the gap and provided a way for individuals to receive necessary medical and mental health services. The door was also opened wider for the industry to be abused by fraudsters.

Brandy McKay, 42, of Cape Girardeau, Mo., jumped into the telehealth gap with both feet and used several of her durable medical equipment (DME) companies to bilk Medicare and Medicaid of more than $7 million in unnecessary medical equipment. (Her victims were super surprised when they received equipment from multiple companies, none of which they had requested or needed.)

McKay carried out her ruse by paying kickbacks for orders and prescriptions that were signed by telemedicine doctors and nurse practitioners. In almost all the cases, the patients had not been examined, nor contacted by the medical personnel. (So how could they accurately diagnose or request DME for patients they had not seen?)

The DME companies that took part in the healthcare fraud scam then submitted reimbursement claims to Medicare and Medicaid for payment. The government healthcare programs reimbursed McKay’s DME companies and her co-conspirators for the unnecessary medical equipment.

McKay pleaded guilty to committing healthcare fraud and was sentenced to three years of prison. She was also ordered to pay $7,520,779 in restitution. (That should serve as a lesson to anyone considering trying to steal taxpayer dollars.) This case is a prime example of how serious the U.S. Government is about identifying and holding accountable those individuals who make the unfortunate choice to carry out health care fraud schemes.

Today’s Fraud of the Day comes from a Department of Justice press release, Judge sentences Cape Girardeau, Missouri woman for Medicare and Medicaid fraud,” dated January 20, 2022.

ST. LOUIS – Brandy McKay, 42, of Cape Girardeau, Missouri appeared before United States District Court Judge Stephen R. Clark on January 18, 2022.  McKay previously pleaded guilty and was sentenced to 3 years imprisonment and ordered to pay $7,520,779.00 in restitution.

According to the plea agreement, between 2017 and 2019, McKay owned or managed multiple durable medical equipment (DME) companies, including three located in Cape Girardeau, Missouri. The DME companies paid kickbacks for orders and prescriptions signed by telemedicine doctors and nurse practitioners, who in almost all cases did not examine the patients, had no contact with the patients, and did not otherwise determine that the patients needed durable medical equipment.

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Larry Benson, Senior Director of Strategic Alliances, LexisNexis Risk Solutions - Government

Larry Benson is responsible for developing strategic partnerships and solutions for the government vertical. His expertise focuses on how government programs are defrauded by criminal groups, and the approaches necessary to prevent them from succeeding.

Mr. Benson has 30 years of experience in sales and business development. Before joining LexisNexis® Risk Solutions, he spent 12 years founding and managing two software technology startups. During the 1990s he spent 10 years as a Regional Director helping to grow a New England-based technology company from 300 employees to 7,000. He started his career with Martin Marietta Aerospace working on laser guided weapons and day/night vision systems.

A sought-after speaker and accomplished writer, Mr. Benson is the principal author of “Fraud of the Day,” a website dedicated to educating government officials about how criminals are defrauding government programs. He has co-authored WTF? Where’s the Fraud? How to Unmask and Stop Identity Fraud’s Drain on Our Government, and Data Personified, How Fraud is Changing the Meaning of Identity.

Benson holds a Bachelor of Science in Physics from Albright College, and earned two graduate degrees – a Master of Business Administration from Florida Institute of Technology, and a Master of Science in Engineering from Lehigh University.