The guy is a grifter, no doubt. But the general tone of the article implies that I should be concerned about some random sleazeball for raising my healthcare costs, rather than the insurance companies themselves (who in this case basically administered the defrauding of their client, Southwest Airlines, by not having proper vetting procedures), the MDs who undoubtedly commit the vast majority of insurance fraud, or policymakers.
I think this is a fair point, that the headline suggests a systemic problem, but its narrative is highly focused on one bad player, albeit someone who took advantage of highly exploitable weaknesses. Full disclosure: I used to work at PP years ago and my time overlapped with the author's, so I'm obviously biased. One takeaway I got was that the system is easy to game – particularly in applying to CMS for a NPI number. And apparently, insurers just assume or don't care that CMS does minimal vetting to stop fraudsters. And currently, it seems insurers are optimized to eat the costs (and ostensibly, pass it on to customers) than to actively root it out, which has its pros and cons ("cons" including being overaggressive and making it harder for regular people to get treatments approved.
While the system overall seems ripe for abuse – the story says CMS officials can't recall any instance in which someone has been sanctioned for applying w/ fraudulent credentials, and it's hard to believe that Williams is the first to discover the vulnerabilities – the story ultimately doesn't know the total costs of this kind of fraud.
Ah, true. But they had lots of family sources and court records for Williams, and I suppose no spokesperson from the insurance companies wanted to talk, so most of the article is just about him. I wish journalists would develop some more sources inside insurance companies, PBMs, etc. How they operate internally is just like a void that nobody wants to look in to, apparently. Like how do they decide what they'll pay for? Or how do they decide who gets to be part of their network? How long will they let a doctor send in fraudulent claims? There are probably 1000 analysts or programmers inside UHC alone who would happily help answer these.
Or the entire article. Sure, the foreground story is about a serial fraudster, but its substance is the cavalcade of systemic failure to do anything about him, or, by implication, any of the innumerable others like him, bilking the system.
If a system shrugs at fraud, what fraud it suffers is substantially that system's fault, IMO. Obviously, mens rea is a thing, but if you're cultivating an environment where bad actors can act badly, you own a heap of that bad.
edit: First-line treatment for sciatica includes typical fitness stretches and "lumbago" just means "back pain" which is treatable with typical fitness exercises: https://www.verywellhealth.com/back-pain-stretches-exercises...