Catch of the Week: 18 Former N.B.A. Players Charged in Healthcare Fraud Scheme
Former professional basketball players, including Terence Williams, “Big Baby” Glen Davis, Sebastian Telfair, and Tony Allen, have been indicted for submitting fraudulent claims for reimbursement of medical and dental services not actually rendered.
From 2017 through last year, defendants’ scheme caused the N.B.A. Players’ Health and Welfare Benefit Plan (“the Plan”) to pay out nearly $4 million in false claims. The Plan, which is funded by NBA member teams, offers healthcare reimbursement account benefits to eligible active and former players of the NBA, providing additional coverage above participants’ medical coverage.
The Game
The government alleges former Louisville star Williams was the orchestrator of the years-long scheme, and that he recruited the others by offering to provide them with fictitious invoices to support false claims for services. The game was to submit these false invoices to the Plan and pocket the reimbursement money.
The invoices purported to document that the named defendants, and, in some cases, members of their families, received expensive medical and dental services that they did not, in fact, receive. Many times, defendants were not even in the vicinity of the service providers on the dates of service listed on the invoices: those dates did not match with GPS location information and/or flight records.
Williams provided the fake invoices from a chiropractic office and dentist, both in California, and a doctor at a wellness clinic in Washington. Apparently, the invoices and other supporting documents raised red flags because they were not on letterhead, had poor formatting, and contained numerous grammatical errors.
Williams pocketed at least $230,000 in kickbacks for providing these falsified invoices to his former N.B.A. colleagues. Former Nets player Douglas Roberts rejected paying kickbacks, favoring instead to submit his own falsified invoices. In an effort to scare him into paying, Williams impersonated a claims officer at the Plan and sent emails to Roberts raising issues with the invoices he submitted.
The Score
Each defendant was charged with one count of conspiracy to commit health care fraud and wire fraud, which carries a maximum sentence of 20 years in prison. Williams was also charged with one count of aggravated identity theft, for impersonating the claims officer, which carries a mandatory minimum sentence of two years in prison.
Manhattan U.S. Attorney Audrey Strauss said: “The defendants’ playbook involved fraud and deception. Thanks to the hard work of our law enforcement partners, their alleged scheme has been disrupted and they will have to answer for their flagrant violations of law.”
As we have previously written, while federal healthcare fraud enforcement typically focuses on fraud against government payors like Medicare, Medicaid, and Tricare, fraud against private insurers can also attract government enforcement. That lesson has now been learned by the 18 defendants charged this week.
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