Senators Call for Closing "Loopholes" That Make Health Care Fraud Easy
Following a detailed account of how scam artists can easily gain access to health care cash, six Democratic senators this week sent a letter to federal regulators urging them to “close loopholes” that allow “bad actors” to commit fraud.
The letter came in response to a recent story by ProPublica and Vox that traced the brazen scam of a Texas personal trainer, who despite having no medical credentials was able to submit a blizzard of fake bills with some of the biggest insurance companies in the country and recoup millions. The story revealed not only how David Williams exploited weaknesses at each step, but how slowly the insurers responded to his ongoing fraud.
Williams’ con, for which he was later prosecuted, was initially enabled by the Centers for Medicare and Medicaid Services. The federal agency issues and administers National Provider Identifiers, or NPIs, the unique numbers medical providers need to bill insurance plans. ProPublica found that Medicare doesn’t check the credentials of medical providers who apply for NPI numbers, such as whether they have valid licenses, which means scammers can lie to obtain them. Williams obtained at least 20 NPI numbers and used them to bill insurers.
The insurers he scammed — Aetna, Cigna and UnitedHealthcare — then allowed his fraud to proceed for years, largely unchecked. The companies also failed to verify that Williams was a licensed physician, even as he billed them for complex, and expensive, office visits as an out-of-network provider. Instead, they paid him more than $4 million over a span of four years, despite alerts from his ex-wife and her dad about his scam. Williams was convicted of four counts of health care fraud in 2018 and sentenced to about nine years in federal prison. The insurers declined to comment on his fraud.
Read more: https://www.propublica.org/article/senators-call-for-closing-loopholes-that-make-health-care-fraud-easy
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