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Home/Legal & Regulatory and Reimbursement/Ortho Pair Plead Guilty to $800k Fraud
Legal & Regulatory and Reimbursement

Ortho Pair Plead Guilty to $800k Fraud

August 18, 2014 2 min read Premium comments

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Ortho Pair Plead Guilty to $800k Fraud
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Two former Integra LifeSciences Holding Corp. employees have pled guilty to defrauding hospitals of more than $800, 000.

Dan Metz was a Northeast regional manager for Integra LifeSciences until he was terminated in April 2013. Charles Carey, Jr. reported to Metz as a product specialist until he resigned in April 2011.

On August 12, 2014, the pair pled guilty to conspiracy to commit wire fraud.

Fraudulent Billing

The New Jersey U.S. Attorney, Paul Fishman, said Metz admitted to using various fraudulent methods to overcharge hospitals and surgery centers. He would sometimes charge for a greater quantity or a more expensive product than was actually used, increasing his compensation and improving his employment evaluations. Metz and Carey admitted that after Metz became regional manager, he taught at least some of the fraudulent methods to product specialists working for him, including Carey, who sometimes employed those methods.

They caused medical facilities to pay more than $800, 000 in inflated bills.

Metz worked at Integra from July 2005 until his termination in April 2013, first as a product specialist (also referred to as a sales representative) and then as Northeast regional manager, supervising 16 product specialists and assistant sales representatives in Massachusetts, New Jersey, New York, and Pennsylvania. Carey was a product specialist, reporting to Metz, from January 2009 until he resigned.

Sentencing and Penalties

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The count of conspiracy to commit wire fraud to which Metz and Carey pleaded guilty carries a maximum potential penalty of 20 years in prison and a $250, 000 fine, or twice the gross gain or loss from the offense. Metz and Carey also agreed to forfeit $100, 000 and $77, 000, respectively, representing the amounts of money they personally made through the fraud scheme.

Sentencing is scheduled for January 20, 2015.

The defrauded hospitals have been reimbursed by Integra for the fraudulent charges.

Christie Successor Record

Fishman, who succeeded Chris Christie as New Jersey U.S. Attorney, reorganized the health care fraud practice shortly after taking office, including creating a stand-alone Health Care and Government Fraud Unit to handle both criminal and civil investigations and prosecutions of health care fraud offenses. Since 2010, the office has recovered more than $540 million in health care fraud and government fraud settlements, judgments, fines, restitution and forfeiture under the False Claims Act, the Food, Drug and Cosmetic Act and other statutes.

React:

Discussion

14
DS
Dr. Sarah MitchellOrthopedic Surgeon · Mayo Clinic

This is a fascinating development. In my practice we've seen similar outcomes with the revised protocol. The key differentiator seems to be patient selection criteria. Has anyone else noticed the correlation with BMI thresholds?

8
JT
James Thornton, MDSpine Fellow · HSS

Great point. I'd push back slightly on the conclusion, the sample size in the cited study is too small to draw population-level inferences. That said, the directional signal is compelling and worth a larger RCT.

5
RP
R. PatelSports Medicine · Stanford

We implemented a similar approach last year. Early results are promising but we're still gathering 12-month follow-up data. Happy to share our protocol if anyone is interested.

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