Escalating health care costs are one of the greatest financial concerns in the United States and 10% of these costs are likely eaten up by fraud, likely because private health insurers preside over about $1.2 trillion in spending each year! Earlier this year, David Williams, with a
The federal department of justice and state Medicaid Fraud Control Units file thousands of criminal and civil cases a year, but we rarely hear about the fraud enforcement efforts of private health insurers, which manage plans of about 150 million Americans who get their health benefits through their employers. Because the pot of money is in the billions, the private insurers’ pick and choose their battles not making fraud a top priority.
So here’s what William did and here was the response from the private insurance giants. Williams, or rather “Dr. Dave”, built a Get Fit With Dave website, built a team, soliciting trainers from the strength and conditioning department at universities and sold his services as covered personal training sessions, but then falsely billing for medical services such as lumbago and sciatica with his favorite billing code of 99215! Even after United was provided all it needed to start a fraud investigation, it moved very slowly, possibly because Southwest self-funds its benefits and pays United to administer the company’s plan and ensure the claims it covered were legitimate. Despite the two-time felony charges and exorbitant bills, United ignored calls or reports of Williams for over two years! And to no one’s surprise, this case was closed in 2016 without any additional information provided. Even after he was found out by United, Aetna
Assuming he pays back the money successfully, how should the people whose health-care premiums, out-of-pocket costs have increased and those