Phila. union (AFSCME) gynecologist gets 3 years in fraud

[Omaha Steve]

http://www.philly.com/inquirer/local/20090725_Phila__union_gynecologist_gets_3_years_in_fraud.html

By Sam Wood

Inquirer Staff Writer
A gynecologist who provided services to members of Philadelphia's largest municipal union was sentenced yesterday to three years in prison for defrauding Independence Blue Cross of more than $780,000.

William King, 61, will not have to report to jail immediately, however. Shortly before he was indicted last year, King, who has hepatitis C, was accepted for an experimental treatment program at Duke University. Because the program does not begin until October, U.S. District Judge Robert F. Kelly delayed the start of King's term until Dec. 1.

King, of Baltimore, treated patients at a clinic at the Walnut Street headquarters of District Council 33 of the American Federation of State, County and Municipal Workers.

From 1999 to 2004, King charged Blue Cross for work he never performed. He billed for fictitious visits by "ghost patients," and he "upcoded" short, routine appointments, claiming they lasted an hour and involved more expensive treatments.

When auditors at Blue Cross became suspicious, King destroyed the medical records of 40 patients and reconstructed their files with fabricated gynecological histories. The FBI was asked to investigate, and in February 2008, King was indicted by the U.S. Attorney's Office.

King was found guilty on Oct. 14 on 13 counts of mail fraud, 59 counts of health-care fraud, and 10 counts of making false statements in a health-care matter.

FULL story at link.