HJNO Sep/Oct 2019

Healthcare Journal of new orleans I  SEP / OCT 2019 29 will investigate further,”she said in the email. Meanwhile, the text messages showed Williams continuing to sign up — and bill for — United members. Frustrated, Pratte made one final call to United in 2016, but he was told the case was closed. United said he’d have to call the Texas Department of Insurance for any additional details. Pratte had already filed a complaint with the regulator but reached out again.The department told him that because he hadn’t personally been defrauded, it would not be able to act on his complaint. To Pratte, it appeared he had struck out withAetna, United, Southwest and the Texas Department of Insurance. “I was trying to get as many people as possible to look into it as I could,”Pratte said recently. “I don’t know if that tells me they are incompetent. Or they don’t care. Or they’re too busy.” A case summary, prepared by the Texas Department of Insurance, shows it first learned of the Williams case in January 2015 but lacked staff to investigate.Aspokes- man said the regulator later received Pratte’s complaint but didn’t pursue it after learn- ing that United had already investigated and closed its case. Meanwhile, some Get Fit With Dave cli- ents had begun noticing odd claims on their insurance statements. Nanette Bishop had heard aboutWilliams when a fellow Southwest flight attendant handed her the trainer’s business card and said, “You’ve got to meet Dr. Dave.” (Bishop said the Southwest legal department advised her not to speak with ProPublica. Details about her interaction with Williams come from court records.) Bishop said she started strong with the workouts but “fizzled”quickly. Her daughter, who was also on her plan and signed up for workouts, only did a couple sessions. Bishop said she had a hard time staying consistent because she was traveling a lot — for much of October 2014 she was in Germany. Later, she noticed in her insurance records that Williams had been paid for dozens of ses- sions over many months, even during the time she’d been abroad. Bishop textedWilliams in January 2015 to tell him he needed to refund all the money. “I never worked out four [times] a week and [my daughter] quit the first week of September,” she wrote. Bishop also called United and SouthwestAirlines to report the overbilling. About a month later, Williams received a letter from a subsidiary of United ordering a review Bishop’s medical records. Another client textedWilliams with con- cerns that her United insurance plan had been billed for 18 workouts in December 2015. That couldn’t be accurate, the woman wrote. “I had to take December off due to my work schedule and family in town,” she wrote. “I understand that people need to be paid but this seems excessive.” While Pratte, Lankford and some of Wil- liams’clients repeatedly flagged bogus bills, the mammoth health insurers reacted with sloth-like urgency to the warnings. Their correspondence shows an almost palpable disinterest in taking decisive action — even while acknowledgingWilliams was fraudu- lently billing them. Cigna appears to have been the quickest to intervene. In January 2015, Cigna sent Williams a letter, noting that he wasn’t a licensed medical provider and had mis- represented the services he provided. The insurer said he needed to pay back $175,528 andwould not be allowed to continue billing. “I just got a $175K bill in the mail,” Wil- liams texted to a friend. “Cigna insurance has been overpaying me for the past 18 months and they want it back. I knew that they were reimbursing at too high of a rate so I can’t really complain.” By then Williams had more than one National Provider Identifier, so he just switched numbers and kept billing Cigna. More than a year later, in May 2016, Cigna sent another letter, saying he now owed $310,309 for inappropriate payments. In total, the company paid him more than $323,000.Williams never gave any of it back. Cigna declined to comment about the Wil- liams case. Aetna wrote Williams in January 2015 to say it had reviewed his claims and found he wasn’t licensed, resulting in an overpayment of $337,933. The letter said there appeared to be “abusive billing” that gave “rise to a reasonable suspicion of fraud.” But the insurer also gave him a month to provide documentation to dispute the assessment. When Williams hadn’t responded in three months, anAetna investigator wrote toWil- liams’attorney, saying, “We are willing to dis- cuss an amicable resolution of this matter,” and gave him two more weeks to respond. That August, anAetna attorney sent Wil- liams’ attorney another letter, noting that Williams had submitted “fraudulent claims” and had continued to submit bills “even after his billing misconduct was identified.” In January 2016 — a year after Aetna first contacted him—Williams agreed to a settle- ment that required him to refund the com- pany $240,000 “without admission of fault or liability by either party.” But that didn’t stop, or even appear to slow, Williams. Not only did he renege on