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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: 2) by The Mighty Buzzard on Monday July 22 2019, @10:33AM (5 children)
Only works if one side of the competition doesn't get to use its bottomless pockets to put the others out of business by eating a loss longer than they can. That's got to be dealt with any time the government is allowed to compete in the private sector or there is no more private sector very soon.
My rights don't end where your fear begins.
(Score: 2, Insightful) by fustakrakich on Monday July 22 2019, @07:22PM (4 children)
It's our pockets, we can use them however we want. That's what voting is about, to determine how our tax dollars are spent. The government is our voice, and wallet. So if we want to compete, we have that right.
And it won't put honest people out of business, only the scammers will feel the pressure.
La politica e i criminali sono la stessa cosa..
(Score: 2) by The Mighty Buzzard on Tuesday July 23 2019, @04:45AM (3 children)
In an ideal world, yes. Not in this one though.
My rights don't end where your fear begins.
(Score: 1) by fustakrakich on Tuesday July 23 2019, @05:00AM (2 children)
Yes, in this one, right here, right now.
La politica e i criminali sono la stessa cosa..
(Score: 2) by The Mighty Buzzard on Tuesday July 23 2019, @09:55AM (1 child)
You probably want to seek psychological help. Specifically, have them check you for schizophrenia. That's a pretty severe departure from reality.
My rights don't end where your fear begins.
(Score: 1) by fustakrakich on Tuesday July 23 2019, @06:22PM
The world is a bit bigger than your view through the pinhole.
Your denials of what is in front of you are the real issue.
La politica e i criminali sono la stessa cosa..