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You are now leaving the Aetna website Links to various non-Aetna sites are provided for your convenience only. Member Log In. This question helps us get you to the correct log-in screen. By , he had 20 NPIs, each allowing him a new stream of billings. For every NPI application, Williams also obtained a new employer identification number, which is used for tax purposes. But he never hid who he was, using his real name, address, phone number and email address on the applications. Medicare officials declined to be interviewed about Williams. Regulations, and potentially the law, would need to be revised to allow the agency to vet the applications, the statement said.
Medicare does verify the credentials of physicians and other medical providers who want to bill the agency for their Medicare patients. To those charged with rooting out fraudsters, the current regulations seem like an invitation to plunder. But since Medicare started issuing NPIs in , officials said they could not identify anyone who had been sanctioned.
So, for those bent on fraud, the first step is easy; the online approval for an NPI takes just minutes. He added a drop-down menu to his site, allowing potential clients to select their health insurance provider: Aetna. Blue Cross Blue Shield. He began building a team, soliciting trainers from the strength and conditioning department at Texas Christian University.
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He met with new recruits at local fast food joints or coffee shops to set them up. To the trainers, the business appeared legit: They even signed tax forms. One Fort Worth trainer recalled meeting Williams through one of his clients, a Southwest Airlines flight attendant.
Health Insurers Make It Easy for Scammers to Steal Millions. Who Pays? You.
Clients came to Williams through his business cards, his website and word-of-mouth. To ensure the clients paid nothing, he waived their annual deductibles — the portion patients pay each year before insurance kicks in. Authorities said Williams banked on being able to file enough claims to quickly blow through their deductibles so he could get paid.
Meredith Glavin, a flight attendant with Southwest, told the authorities she got in touch with Williams after her co-workers said insurance was covering their workouts. My services will be covered at no cost to you. During a follow-up phone call, Glavin said, they discussed her fitness and weight loss goals and then Williams connected her with a trainer. The workouts were typical fitness exercises, she said, not treatment for a medical condition. The code is supposed to be used less often because it requires a comprehensive examination and sophisticated medical decision-making, warranting higher reimbursement.
Eventually, Get Fit With Dave expanded to about a dozen trainers and around 1, patients, said a source familiar with the case.