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.
Dr. Dave scammed his way to $4 million.
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.”
Cindy Dahdah scammed her way to $2 million.
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.
Dahdah has been sentenced to 60 months in prison.
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.”
Are you an attorney who is currently trying a health care fraud case?
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