Swoosh! – 18 former NBA players allegedly engaged in a scheme to defraud the NBA Players’ Health and Welfare Benefit Plan – sending it home for $4M. How did they do it?  Glad you asked.  Well, the way everyone does it (well almost everyone), is by submitting fake reimbursement claims for medical and dental services that were never received.

Same game, different players: back in 2019, 10 former NFL players were charged by federal prosecutors for being part of their healthcare fraud scheme, and in the next year, 5 more retired players were charged.  For the Hail Mary of healthcare fraud, what did they do?  Of course, they submitted false claims to the Gene Upshaw NFL Player Health Reimbursement Account Plan.  Interesting that they were charged in 2019 and the plan was only created in 2006.  It took less than a decade and a half to find fraud.  We aren’t surprised.  The false claims were paid out for expensive medical equipment that was never obtained.  We see durable medical equipment (DME) fraud all the time.  You see it too – how many times has little Timmy, your cousin/nephew (whatever), gotten the substandard or unneeded brace?  Not medically necessary, ineligible, not provided…all of these are classic hall of fame DME schemes. 

So, from getting charged to the Super Bowl, I would say the healthcare fraud Super Bowl is getting sent to the clink – did the former NFL players get sent to jail?  They were charged back in 2019, it is the end of 2021, some quick finger math tells me it has been a few years…well okay, everything stopped during COVID, right?  WRONG! It’s never too early to pay for your mistakes when it comes to defrauding healthcare.  Well, at least it’s never too early in my opinion.  In real life, the lifecycle of charged to prison takes a long time.  In September of this year, three former players pleaded guilty, and sentencing will begin in November for one, and two of the others in January.  Read more here:

I will sit on the sidelines and wait to see how long it takes for the NBA players to actually have anything happen.  Basketball is a very fast-moving game, but as you can see by my frustration, healthcare fraud prosecution is a slow roll.

By: Jeanmarie Loria