Allegiant Experts
Jul 19, 20193 min
Just how easy is it to commit health care fraud? You’d have to assume that, with all of the news stories about people ripping off health insurance programs in our nation, it’s not the hardest thing in the world to pull off. On Vox.com, Marshall Allen shares a very interesting story about a man named David Williams, a physical therapist and personal trainer, who used his Get Fit With Dave business to scam millions away from health insurers.
For more than four years, Williams ran a scheme that
involved the billing of insurance companies for his services even though he
didn’t have a medical license and wasn’t qualified to submit such billings.
Calling himself “Dr. Dave”, Williams made out with about $4 million before
being caught in the act.
“Williams’ case highlights an unsettling reality
about the nation’s health insurance system,” writes Allen, “It is surprisingly
easy for fraudsters to gain entry, and it is shockingly difficult to convince
insurance companies to stop them.”
61 year-old Cindy Dahdah of Beavercreek, Ohio is yet another perpetrator of health care fraud who, at one time, made it look easy. According to the Southern District of Ohio branch of the United States Department of Justice, the licensed cardiologist owned a medical and dental billing company and made out with more than $2 million in cash thanks to her role in committing health care fraud.
“According to court documents and testimony, Dahdah
and her late husband, Dr. Salim Dahdah, conspired to commit health care fraud
from 2007 until 2015,” reports the DoJ, “The defendants provided medically
unnecessary medical tests and procedures – including nuclear stress tests and
invasive cardiac procedures – exposing patients to the risk of serious physical
harm.”
The report also states that the Dahdahs created
aggressive medical protocols for cardiac related tests and procedures that they
required OICC and ACCU-BIL staff to follow regardless of the medical necessity
of the procedures. They would name a patient’s last seen physician as a
referring physician for invasive and unnecessary procedures, even though the
last physician never ordered the procedures.
In order to ensure their protocols were strictly
followed, Cindy Dahdah would often reprimand, humiliate or even threaten to
terminate employees who refused to schedule the medical tests.
While capturing, charging and convicting fraudsters
may be a bit harder than the act of committing fraud itself, it has not
deterred law enforcement one bit.
Benjamin C. Glassman is the United States Attorney
for the Southern District of Ohio. “The Dahdahs subjected patients to
unnecessary nuclear stress tests and invasive cardiac procedures in order to
make a quick buck off Medicare and Medicaid,” he is quoted as saying in the DoJ
report, “What an unconscionable business model. The defendant’s prison term is
well deserved.”
Please don’t hesitate to contact Allegiant Experts to find out how our clinical expertise may help your case. Our experts have been providing expert clinical services for nearly two decades and can help your team by bridging the disciplines of medicine, coding and billing to ensure accurate payment and data is achieved. Give us a call at 407-217-5831 or email us at info@allegiantexperts.com.
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