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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.
(Score: 1, Interesting) by Anonymous Coward on Monday July 22 2019, @07:51AM (1 child)
Our current system of corporatism is nothing like the capitalism as laid out in the Wealth of Nations. The only difference between the US and the Soviet Union is that instead of being run by corrupt alcoholic Russians we were ruled by corrupt Episcopalians and Irishmen that we traded for Jews as the 50s turned to the 60s. The only capitalists we have had in a hundred and fifty years are probably TR and Nixon. Capitalism as laid out in the Wealth of Nations was not this Libertarian pipe dream of NAP and non-regulation, it was enforcing pro-competition practices at the federal level including breaking up monopolies. Today we are instead ran by an oligarchy of the most powerful companies who instead use the federal government to squash small business and ensure continued corporate profits, this system is closer to the highly regulated soviet system with less starvation, a dressing of hope, and a sprinkle of freedom.
(Score: 2) by Azuma Hazuki on Monday July 22 2019, @09:57PM
Yup. State capitalism. Running the nation-state like a business for the material advantages of the heads of state. You took a lot of words to agree with me, and also threw in a bunch of weird ethnic and religious slurs.
I am "that girl" your mother warned you about...