Topics
More on Compliance & Legal

Personal trainer charged with posing as physician in $25 million fraud

Texas man certified himself with CMS as healthcare provider allegedly to bill insurance carrier for services, made more than $3.9 million, DOJ said.

Beth Jones Sanborn, Managing Editor

A Texas man who masqueraded as a physician on paper has been arrested and charged with engaging in an insurance fraud scheme that caused the submission of more than $25 million in false and fraudulent claims for medical services, the U.S. Department of Justice announced.

According the DOJ,the criminal complaint states that David Williams, 54, of Fort Worth, advertised on his website between November 2012 through August 2017, getfitwithdave.com, offering in-home fitness training and therapy through his company, "Kinesiology Specialists."  He identified himself as "Dr. Dave" with clients in Texas, Las Vegas, Denver, Tucson, Seattle, and Orlando, saying that he accepted most healthcare insurance coverage plans.

[Also: Running list of notable 2017 healthcare frauds]

Williams registered as a healthcare provider with the Centers for Medicare and Medicaid Services allegedly so he could bill insurance companies for services, completing the application and falsely certifying that he was a healthcare provider, enrolling as such at least nineteen times under different names or variations of his name, and his company names, falsely certifying that he was a healthcare provider in each application, the DOJ said. 

"Williams would then bill the insurance companies as if he were a medical physician and as if he had provided care requiring medical decision making of high complexity when Williams actually provided fitness and exercise training to his clients."

The DOJ also said that according to the criminal complaint affidavit, Williams recruited potential clients through various means and would meet with or speak with them over the phone, reviewing their health history and goals for their planned fitness training, and eventually assigning a trainer who typically met with the client between one and three times a week for approximately one-hour fitness training sessions. Williams would then bill insurance companies for those sessions using inaccurate codes, sometimes billing for services that neither he nor his staff, ever provided.

Between November 2012 through August 2017, Williams was paid more than $3.9 million in connection with his fraudulent billing of United HealthCare Services, Aetna and Cigna, the DOJ said. The maximum statutory penalty for the charged offense is 10 years in federal prison and a $250,000 fine.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com

Show All Comments