Fort Worth Man Arrested on $25 Million Health Care Fraud Scheme
FORT WORTH, Texas — A Fort Worth, Texas, man, David Williams, 54, was arrested yesterday by special agents with the Federal Bureau of Investigation on a federal complaint charging him with engaging in a scheme to defraud insurance companies by submitting over $25 million in false and fraudulent claims for medical services. The announcement was made today by U.S. Attorney John Parker of the Northern District of Texas.
Williams made his initial appearance yesterday before U.S. Magistrate Judge Jeffrey L. Cureton and will remain on bond pending further court hearings.
According to the criminal complaint affidavit, between November 2012 through August 2017, Williams advertised on his website, getfitwithdave.com that he offered in-home fitness training and therapy through his company, “Kinesiology Specialists.” Williams identified himself as “Dr. Dave” and stated that he served clients in most of Texas, Las Vegas, Denver, Tucson, Seattle, and Orlando. Through his website, Williams told potential clients that he was accepting most health care insurance coverage plans.
In order to bill insurance companies for his services, Williams registered as a health care provider with the Centers for Medicare and Medicaid Services. In completing the application, Williams falsely certified that he was a health care provider. Williams enrolled as a health care provider at least nineteen times under different names or variations of his name and his company names and falsely certified that he was a health care provider in each application. 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.
According to the criminal complaint affidavit, Williams recruited potential clients through the use of flyers, the internet, and word-of-mouth. Once recruited, Williams would typically meet with or speak with the new client over the phone and review their health history and goals for their planned fitness training. Williams would then typically assign a personal trainer to that individual. The personal trainer typically met with the client between one and three times a week for approximately one hour and provided fitness training. Williams would then bill insurance companies for each training session using inaccurate codes and on certain occasions, billed for services that neither he nor his staff, ever provided.
Between November 2012 through August 2017, Williams was paid in excess of $3.9 million in relation to his fraudulent billing of United HealthCare Services, Inc., Aetna, Inc., and Cigna.
A federal criminal complaint is a written statement of the essential facts of the offense charged, and must be made under oath before a magistrate judge. A defendant is entitled to the presumption of innocence until proven guilty. The U.S. Attorney’s office has 30 days to present the matter to a grand jury for indictment. The maximum statutory penalty for the charged offense is 10 years in federal prison and a $250,000 fine.
The investigation is being conducted by the FBI. Assistant U.S. Attorney P.J. Meitl is in charge of the prosecution.
Tags: Health Care Fraud