DOJ: Personal trainer posed as physician in $25M scheme


https://www.beckershospitalreview.com/legal-regulatory-issues/doj-personal-trainer-posed-as-physician-in-25m-scheme.html

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A 54-year-old personal trainer was arrested in Fort Worth, Texas, Oct. 12, and charged with engaging in a scheme to defraud insurance companies by submitting more than $25 million in false claims for medical services, according to the Department of Justice.

The government claims David Williams, the personal trainer, identified himself as “Dr. Dave” on his website and said he offered in-home fitness training and therapy. Mr. Williams’ website stated he accepted most health insurance plans, according to the DOJ.

To bill health insurance companies for his fitness and exercise training services, Mr. Williams allegedly registered as a healthcare provider with CMS and then billed insurance companies as if he were a physician. He allegedly used different names to enroll as a healthcare provider at least 19 times.

The government alleges Mr. Williams used inaccurate codes to bill for the services he and his staff provided, and he sometimes billed for services that had not been provided.

From November 2012 through August 2017, Mr. Williams submitted $25 million in false claims to UnitedHealthcare, Aetna and Cigna, and he was paid more than $3.9 million in relation to those claims.

If proven guilty, Mr. Williams faces up to 10 years in federal prison and a $250,000 fine.

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