You don't have to be a doctor or even in the health care business to commit health care fraud. A judge court just sentenced an Orchard Park, N.Y., gym owner to three years probation and 100 hours of community service for defrauding private insurers with fake fitness sessions -- including a couple allegedly attended by dead people.
There's an elder fitness program called Silver Sneakers with which several insurers collaborate to help get ailing seniors active again. According to the complaint sworn by FBI agent David Budz, Silver Sneakers users are given a swipe card for use at participating health clubs, and beneficiaries "must actually have attended a session to entitle the health club to submit a claim for reimbursement" from the insurer. This is tabulated by use of membership cards, which note the date and time of attendance when swiped at the club.
The Spring Creek Athletic Club (SCAC) in Springville, N.Y., was one of those participating facilities, but a citizen ratted out its owner, Gary Wannemacher, to the feds for "swiping the Silver Sneakers membership cards at SCAC for classes even though the beneficiary was not at the particular classes."
The FBI interviewed a number of beneficiaries and learned that Wannamacher kept their membership cards for them and that some of the alleged dates and times of their use occurred when the beneficaries were out of town or in the hospital.
For two beneficiaries, the complaint further states, the cards were swiped "for sessions purportedly attended by two members after their dates of death."
The FBI identified hundreds of fraudulent sessions billed to Independent Health Association and HealthNow/BlueCross BlueShield of Western New York. Wannemacher, who was sentenced on Nov. 12, will pay $57,373.86 in restitution.