HJBR Sep/Oct 2019

Healthcare Journal of baton rouge I  SEP / OCT 2019 27 clients through higher premiums and out- of-pocket fees or reduced coverage. Insurance companies “are more focused on their bottom line than ferreting out bad actors,” said Michael Elliott, former lead attorney for theMedicare Fraud Strike Force in North Texas. As Lankford looked at the iPad that day, she knew something else that made Wil- liams’ romp through the health care sys- tem all the more surprising. The personal trainer had already done jail time for a simi- lar crime, and Lankford’s father had uncov- ered the scheme. Scanning her ex-husband’s texts, Lank- ford, then 47, knew just who to call. Dur- ing the rocky end of her marriage, her dad had become the family watchdog. JimPratte has an MBA in finance and retired after a career selling computer hardware, but even themention ofWilliams flushed his face red and ratcheted up his Texas twang. His for- mer-son-in law is the reason he underwent firearms training. Lankford lived a fewminutes away from her parents in Mansfield. She brought her dad the iPad and they pored over message after message inwhichWilliams assured cli- ents that their insurance would cover their workouts at no cost to them. Lankford and Pratte, then 68, were stunned at Williams’ audacity. They were sure the companies would quickly crack- down on what appeared to be a fraudulent scheme. Especially becauseWilliams had a criminal record. In early 2006, while Williams and Lank- ford were going through their divorce, the family computer started freezing up. Lank- ford asked her dad to help her recover a document. Scrolling through the hard drive, Pratte came upon a folder named “Invoices,” and he suspected it had something to do withWilliams. His soon to be ex-son-in-law had had a promising start. He’d wrestled and earned bachelor’s and master’s degrees at Boise State University, and a Ph.D. at Texas A&M University, before landing a well-paying job as a community college professor inArling- ton. But the glow fadedwhen the school sud- denly fired him for reasons hidden by a con- fidential settlement and byWilliams himself, who refused to reveal themeven to his wife. Out of a job, Williams had hustled invest- ments from their friends to convert an old Winn-Dixie grocery store into a health club called “Doc’s Gym.”The deal fell apart and everyone lost their money. The failure was written up in the local newspaper under the headline: “What’s up with Doc’s?” Inside the “Invoices” folder, Pratte found about a dozen bills that appeared to be from a Fort Worth nonprofit organization where his daughter and Williams took their son Jake for autism treatment. As Pratte sus- pected, the invoices turned out to be fake. Williams had pretended to take Jake for therapy, then created the false bills so he could pocket a cash “reimbursement” from a county agency. In November 2008, Williams pleaded guilty in Tarrant County District Court to felony theft. He was sentenced to 18months in jail and was released on bail while he appealed. Things took an even darker turn about two years later when Williams and Lank- ford’s 11-year-old son showed up to school with bruising on his face. Investigators determined that Williams had hit the boy in the face about 20 times. Williams pleaded guilty to causing bodily injury to a child, a felony, which, coupled with the bail viola- tion, landed him in jail for about two years. The time behind bars didn’t go to waste. Williams revised the business plan for Get Fit With Dave, concluding he needed to get access to health insurance. Williams detailed his plans in letters to Steve Cosio, a tech-savvy friend who ran the Get Fit With Dave website in exchange for personal training sessions. Cosio, whose name later popped up on Lankford’s son’s iPad, kept the letters in their original enve- lopes and shared themwith ProPublica. He said he never suspectedWilliams was doing anything illegal. In his letters, Williams said that when he got out, instead of training clients himself, he would recruit clients and other trainers to run the sessions. “It has the potential for increased revenue.” He asked Cosio to remove the term “per- sonal training” from his website in another letter, adding “95 percent of my clients are paid for by insurance, which does not cover ‘personal training,’ I have to bill it as ‘ther- apeutic exercise.’ It is the same thing, but I have to play the insurance game … Insurance pays twice as much as cash pay so I have to go after that market.” Williams downplayed his child abuse con- viction — “I can honestly say that I am the “In 2017, private insurance spending hit $1.2 trillion, according to the federal government, yet no one tracks howmuch is lost to fraud. Some investigators and health care experts estimate that fraud eats up 10% of all health care spending, and they know schemes abound.” 10%