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posted by chromas on Sunday July 21 2019, @10:01AM   Printer-friendly
from the ever-wonder-why-health-care-is-so-expensive dept.

Ever since her 14-year marriage imploded in financial chaos and a protective order, Amy Lankford had kept a wary eye on her ex, David Williams.

Williams, then 51, with the beefy body of a former wrestler gone slightly to seed, was always working the angles, looking for shortcuts to success and mostly stumbling. During their marriage, Lankford had been forced to work overtime as a physical therapist when his personal training business couldn't pay his share of the bills.

So, when Williams gave their three kids iPad Minis for Christmas in 2013, she was immediately suspicious. Where did he get that kind of money? Then one day on her son's iPad, she noticed numbers next to the green iMessage icon indicating that new text messages were waiting. She clicked.

What she saw next made her heart pound. Somehow the iPad had become linked to her ex-husband's personal Apple device and the messages were for him.

Most of the texts were from people setting up workouts through his personal training business, Get Fit With Dave, which he ran out of his home in Mansfield, Texas, a suburb of Fort Worth. But, oddly, they were also providing their birthdates and the group number of their health insurance plans. The people had health benefits administered by industry giants, including Aetna, Cigna and UnitedHealthcare. They were pleased to hear their health plans would now pay for their fitness workouts.

Lankford's mind raced as she scrolled through the messages. It appeared her ex-husband was getting insurance companies to pay for his personal training services. But how could that be possible? Insurance companies pay for care that's medically necessary, not sessions of dumbbell curls and lunges.

Insurance companies also only pay for care provided by licensed medical providers, like doctors or nurses. Williams called himself "Dr. Dave" because he had a Ph.D. in kinesiology. But he didn't have a medical license. He wasn't qualified to bill insurance companies. But, Lankford could see, he was doing it anyway.

As Lankford would learn, "Dr. Dave" had wrongfully obtained, with breathtaking ease, federal identification numbers that allowed him to fraudulently bill insurers as a physician for services to about 1,000 people. Then he battered the system with the bluntest of ploys: submit a deluge of out-of-network claims, confident that insurers would blindly approve a healthy percentage of them. Then, if the insurers did object, he gambled that they had scant appetite for a fight.

By the time the authorities stopped Williams, three years had passed since Lankford had discovered the text messages. In total, records show, he ran the scheme for more than four years, fraudulently billing several of the nation's top insurance companies — United, Aetna and Cigna — for $25 million and reaping about $4 million in cash.

Read the rest at ProPublica.


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  • (Score: 4, Informative) by PartTimeZombie on Sunday July 21 2019, @08:55PM (8 children)

    by PartTimeZombie (4827) on Sunday July 21 2019, @08:55PM (#869717)

    Right, like Germ Theory (European)

    Antibiotics (European),

    X-Rays (European)

    Magnetic resonance imaging (European)

    To name just a few. What the US health system is really good for is monetizing those inventions.

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  • (Score: 0) by Anonymous Coward on Monday July 22 2019, @12:05AM (3 children)

    by Anonymous Coward on Monday July 22 2019, @12:05AM (#869774)

    I didn't check the others but at least MRI is wrong:

    Raymond Vahan Damadian (born March 16, 1936) is an American physician, medical practitioner, and Mb>inventor of the first MR (Magnetic Resonance) Scanning Machine.

    https://en.wikipedia.org/wiki/Raymond_Damadian [wikipedia.org]

    • (Score: 2) by PartTimeZombie on Monday July 22 2019, @12:19AM (2 children)

      by PartTimeZombie (4827) on Monday July 22 2019, @12:19AM (#869779)

      It is not really wrong.

      Peter Mansfield had something to do with it too. [wikipedia.org]

      Peter Mansfield of the University of Nottingham in the United Kingdom took Lauterbur's initial work another step further, replacing the slow (and prone to artefacts) projection-reconstruction method used by Lautebur's original technique with a method that used frequency and phase encoding by spatial gradients of magnetic field. Owing to Larmor precession, a mathematical technique called a Fourier transformation could then be used to recover the desired image, greatly speeding up the imaging process.

      Also:

      John Francis Bovell was the first person to have an MRI scan in the UK in Southampton General Hospital.

      • (Score: 0) by Anonymous Coward on Monday July 22 2019, @01:05AM (1 child)

        by Anonymous Coward on Monday July 22 2019, @01:05AM (#869785)

        If minor minor tweaks count as inventing something then good luck attributing anything to one country.

        • (Score: 2) by PartTimeZombie on Monday July 22 2019, @01:32AM

          by PartTimeZombie (4827) on Monday July 22 2019, @01:32AM (#869790)

          If making the first practical MRI scanner counts as a "minor tweak" then sure, OK.

          Not that you're wrong though. Lots of people had a hand in that invention.

  • (Score: 2) by The Mighty Buzzard on Monday July 22 2019, @10:37AM (3 children)

    Those are three good ones, yes. Three. Out of a whole lot more than three.

    Also, it's a nit-pick but you don't get to claim all antibiotics by inventing the first.

    --
    My rights don't end where your fear begins.
    • (Score: 2) by PartTimeZombie on Monday July 22 2019, @08:09PM (2 children)

      by PartTimeZombie (4827) on Monday July 22 2019, @08:09PM (#870063)

      You're right, it is a nit-pick.

      I am still wondering what fundamental discoveries the mighty US capitalist medical industry made?

      I can't think of any, except maybe $3,000 ambulance rides.

      • (Score: 2) by The Mighty Buzzard on Tuesday July 23 2019, @04:48AM (1 child)

        The majority, not plurality but majority, of medical advances in the past century or so were made in the US. If you can't even think of one, then you're actively blocking reality from entering your memory to keep it from upsetting your worldview.

        --
        My rights don't end where your fear begins.