Get help, info, and resources to manage your disease and treatment. We're also here for you when you're healthy with fitness discounts , preventive care info , and shots. Stay up-to-date with health info and resources through our blog and social media. And with Your Health Alliance , you have instant access to helpful tools and your plan benefits and claims. Plans Benefits Resources Help.
Are you sure you want to navigate away from this page?
Looking for Quality Health Insurance? Medicare Plans Medicare Plans. Already a Member? Federal Employee? Connect to plan materials and resources. See our NCQA rankings and more. Finding care. Where you are. Be Your Best Beyond great coverage, we also want to help you take charge of your health. Rally Use Rally , our easy-to-use digital health experience, to improve your health in small ways. Health and Wellness Get help, info, and resources to manage your disease and treatment.
Student Health Benefit Plan (SHBP)
Benefits We're also here for you when you're healthy with fitness discounts , preventive care info , and shots. Our Blog Stay up-to-date with health info and resources through our blog and social media. 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.
It appeared her ex-husband was getting insurance companies to pay for his personal training services.
On a mission to empower.
But how could that be possible? Insurance companies also only pay for care provided by licensed medical providers, like doctors or nurses. But, Lankford could see, he was doing it anyway. 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 response to inquiries, Williams sent a brief handwritten letter. Most people assume their insurance companies are tightly controlling their health care dollars. Insurers themselves boast of this on their websites. Policing criminals eats away at them. Ultimately, losses are passed on to their clients through higher premiums and out-of-pocket fees or reduced coverage. During the rocky end of her marriage, her dad had become the family watchdog. Jim Pratte has an MBA in finance and retired after a career selling computer hardware, but even the mention of Williams flushed his face red and ratcheted up his Texas twang.
His former-son-in law is the reason he underwent firearms training. Lankford lived a few minutes away from her parents in Mansfield. She brought her dad the iPad and they pored over message after message in which Williams assured clients that their insurance would cover their workouts at no cost to them. They were sure the companies would quickly crackdown on what appeared to be a fraudulent scheme. In early , while Williams and Lankford were going through their divorce, the family computer started freezing up.
Lankford asked her dad to help her recover a document. His soon to be ex-son-in-law had had a promising start. But the glow faded when the school suddenly fired him for reasons hidden by a confidential settlement and by Williams himself, who refused to reveal them even to his wife. As Pratte suspected, the invoices turned out to be fake.
He was sentenced to 18 months in jail and was released on bail while he appealed.
- Your Provider Networks:.
- free iowa death marriage divorce records.
- divorce records for tuscaloosa county alabama.
- how do you find your friend id number on myspace.
Investigators determined that Williams had hit the boy in the face about 20 times. Williams pleaded guilty to causing bodily injury to a child, a felony, which, coupled with the bail violation, landed him in jail for about two years. Williams revised the business plan for Get Fit With Dave, concluding he needed to get access to health insurance.
- Cigna HealthCare Open Access Plus (OAP) Network.
- free access to criminal background check.
- Medical Assistance Managed Care (Medicaid);
Williams detailed his plans in letters to Steve Cosio, a tech-savvy friend who ran the Get Fit With Dave website in exchange for personal training sessions. He said he never suspected Williams was doing anything illegal. In his letters, Williams said that when he got out, instead of training clients himself, he would recruit clients and other trainers to run the sessions. He is the reason for my new accommodations. To set his plan in motion, Williams needed what is essentially the key that unlocks access to health care dollars: a National Provider Identifier, or NPI number.
One would think obtaining an NPI, with its stamp of legitimacy, would entail at least some basic vetting. Records show Williams first applied for an NPI under his own name as far back as The following year, he picked up another under Mansfield Therapy Associates. In , he obtained at least 11 more, often for entities he created in the areas where he found fitness clients: Dallas, Nevada, North Texas and more. By , he had 20 NPIs, each allowing him a new stream of billings. For every NPI application, Williams also obtained a new employer identification number, which is used for tax purposes.
But he never hid who he was, using his real name, address, phone number and email address on the applications. Medicare officials declined to be interviewed about Williams. Regulations, and potentially the law, would need to be revised to allow the agency to vet the applications, the statement said. Medicare does verify the credentials of physicians and other medical providers who want to bill the agency for their Medicare patients.
To those charged with rooting out fraudsters, the current regulations seem like an invitation to plunder. But since Medicare started issuing NPIs in , officials said they could not identify anyone who had been sanctioned. So, for those bent on fraud, the first step is easy; the online approval for an NPI takes just minutes. He added a drop-down menu to his site, allowing potential clients to select their health insurance provider: Aetna. Blue Cross Blue Shield.
He began building a team, soliciting trainers from the strength and conditioning department at Texas Christian University.
He met with new recruits at local fast food joints or coffee shops to set them up. To the trainers, the business appeared legit: They even signed tax forms. One Fort Worth trainer recalled meeting Williams through one of his clients, a Southwest Airlines flight attendant. Clients came to Williams through his business cards, his website and word-of-mouth. To ensure the clients paid nothing, he waived their annual deductibles — the portion patients pay each year before insurance kicks in. Authorities said Williams banked on being able to file enough claims to quickly blow through their deductibles so he could get paid.
Final Forms and Instructions for IRS Reporting Requirements
Meredith Glavin, a flight attendant with Southwest, told the authorities she got in touch with Williams after her co-workers said insurance was covering their workouts. My services will be covered at no cost to you. During a follow-up phone call, Glavin said, they discussed her fitness and weight loss goals and then Williams connected her with a trainer. The workouts were typical fitness exercises, she said, not treatment for a medical condition. The code is supposed to be used less often because it requires a comprehensive examination and sophisticated medical decision-making, warranting higher reimbursement.
Eventually, Get Fit With Dave expanded to about a dozen trainers and around 1, patients, said a source familiar with the case. Williams bought a couple of pick-up trucks, a new Harley Davidson motorcycle and a fancy house. It is not about the money. I have had a lot taken away from me, and maybe I am trying to prove something Maybe it is my way of giving the finger to everyone???
The texts appeared boring, even routine, but Pratte knew they were evidence of ongoing fraud. How often do they get cases wrapped up in a bow? But when he and Lankford began contacting insurers, they were soon bewildered.
Lankford, who happened to be covered by Aetna, made the complaint, but they say they never heard back. A supervisory investigator called to ask for the names of personal trainers, which Lankford provided. But, again, there was silence. Pratte could see many of the clients worked for Southwest and had their benefits administered by United.
He jotted down the name, address, phone number, birthdate and member identification number of the potential clients on a yellow legal pad — all the information the insurer and Southwest would need to investigate the fraud. This is so easy, Pratte recalled thinking as he wrote down the details, all they have to do is cross-reference this. Pratte said he called the airline in the fall of and spoke to someone in the human resources department who said they would pass the information to the right people. Southwest declined to comment for this story.
It still pays United to administer its benefits. Pratte started calling United in the fall of and spoke to a fraud investigator who took the information with interest, he said. But within a couple of weeks he was told she moved to a different position. Pratte continued calling United over the following two years, making about a dozen calls in total, he said. In early , Lankford emailed additional information to the investigator.