Fort Worth trainer Dr. Dave accused of $25 million health care fraud

[TexasTowelie]

FORT WORTH -- He calls himself “Dr. Dave” and his website promotes personal training to “enhance your lifestyle.”

But for nearly five years, Fort Worth’s David Williams used his Kinesiology Specialists business to defraud health insurance companies out of more than $25 million, billing the companies for medical services even though he wasn’t a medical doctor, authorities said Friday.

When federal agents told him in May that they were investigating him for fraud, he continued fraudulently billing one of the companies under a different business name, a criminal complaint said.

Williams, 54, was arrested Thursday on a felony charge of healthcare fraud, punishable by up to 10 years in prison and a $250,000 fine.

Read more here: http://www.star-telegram.com/news/local/community/fort-worth/article178779236.html

[nitpicker]

1. From the DoJ PR

https://www.justice.gov/usao-ndtx/pr/fort-worth-man-arrested-25-million-health-care-fraud-scheme

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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.
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